Provider Demographics
NPI:1194722207
Name:EBEL, JAY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALLEN
Last Name:EBEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 - 7TH STREET, #15
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352
Mailing Address - Country:US
Mailing Address - Phone:952-378-1030
Mailing Address - Fax:952-378-1030
Practice Address - Street 1:2330 SIOUX TRAIL N.W.
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372
Practice Address - Country:US
Practice Address - Phone:952-233-4271
Practice Address - Fax:952-233-4224
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND538111N00000X
MN3038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C096CBOtherBCBS
ND17722Medicaid
MN3C095HAOtherBCBS
ND11445OtherBCBS
MN3C096CBOtherBCBS
MN3C095HAOtherBCBS