Individual
JILL M BRAATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
750 1ST STREET SOUTH, SUITE 103, WAITE PARK, MN 56387
(320) 240-6561
Mailing address
750 1ST STREET SOUTH, SUITE 103, WAITE PARK, MN 56387
(320) 240-6561
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4986
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350004055
MEDICARE PTAN
MN
01
—
36M21BR
BLUE CROSS BLUE SHIELD PROVIDER ID
MN
Enumeration date
01/25/2008
Last updated
10/20/2008
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