Provider Demographics
NPI:1932618543
Name:SAUL, JACQUELINE ANNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANNETTE
Last Name:SAUL
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 1:110 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1621
Mailing Address - Country:US
Mailing Address - Phone:952-607-8465
Mailing Address - Fax:
Practice Address - Street 1:140 HOLMES ST S
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1329
Practice Address - Country:US
Practice Address - Phone:952-607-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN952754500023OtherLLC CERTIFICATE OF ORGANIZATION
MN1609OtherACTIVE PROFESSIONAL FIRM
MN6385OtherACTIVE DOCTOR OF CHIROPRACTIC