Individual
DR. JASON MICHAEL FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
8200 HUMBOLDT AVE S STE 204, BLOOMINGTON, MN 55431-1432
(952) 884-6144
(952) 884-9180
Mailing address
8200 HUMBOLDT AVE S, STE 204, BLOOMINGTON, MN 55431-1432
(612) 386-0333
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3651
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5328276-00
—
MN
Enumeration date
05/16/2007
Last updated
03/06/2017
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