Provider Demographics
NPI:1215076591
Name:HILDENBRAND, JAY DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:DOUGLAS
Last Name:HILDENBRAND
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 1:2406 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2004
Mailing Address - Country:US
Mailing Address - Phone:218-263-8898
Mailing Address - Fax:
Practice Address - Street 1:3605 MAYFAIR AVE
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2935
Practice Address - Country:US
Practice Address - Phone:218-262-3441
Practice Address - Fax:218-362-6989
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003966OtherMEDICARE
MN839655800Medicaid