Provider Demographics
NPI:1699975631
Name:SHOFF, MICHAEL JAY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:SHOFF
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 1:2621 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1925
Mailing Address - Country:US
Mailing Address - Phone:612-722-8554
Mailing Address - Fax:612-722-1041
Practice Address - Street 1:2621 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1925
Practice Address - Country:US
Practice Address - Phone:612-722-8554
Practice Address - Fax:612-722-1041
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN768527100Medicaid
MN30340SHOtherBLUE CROSS/BLUE SHIELD
MNT40052Medicare UPIN
MN350000351Medicare PIN