Individual
JACK BALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
7400 33RD ST N STE 100, OAKDALE, MN 55128-3630
(651) 241-9240
Mailing address
7400 33RD ST N STE 100, OAKDALE, MN 55128-3630
(651) 241-9240
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
68496
MN
207Q00000X
Family Medicine Physician
Primary
68496
MN
208D00000X
General Practice Physician
2018039614
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3407536
U OF MN EMPLOYEE
—
Enumeration date
04/20/2016
Last updated
11/16/2022
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