Provider Demographics
NPI:1306023353
Name:PLOEGER, JONATHAN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:PLOEGER
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 1:280 12TH ST SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-3778
Mailing Address - Country:US
Mailing Address - Phone:612-760-6621
Mailing Address - Fax:
Practice Address - Street 1:12501 NICOLLET AVE
Practice Address - Street 2:SUITE 323
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5901
Practice Address - Country:US
Practice Address - Phone:612-760-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor