Provider Demographics
NPI:1528104619
Name:BAKKEGARD, JODI ELLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:ELLEN
Last Name:BAKKEGARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1437
Mailing Address - Country:US
Mailing Address - Phone:612-929-2168
Mailing Address - Fax:
Practice Address - Street 1:3304 W 44TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1437
Practice Address - Country:US
Practice Address - Phone:612-929-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor