Provider Demographics
NPI:1962414789
Name:PLADSON, JEFFREY SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:PLADSON
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 1:420 CENTER AVE
Mailing Address - Street 2:SUITE 48
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1957
Mailing Address - Country:US
Mailing Address - Phone:218-236-5151
Mailing Address - Fax:218-236-5866
Practice Address - Street 1:420 CENTER AVE
Practice Address - Street 2:SUITE 48
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-1962
Practice Address - Country:US
Practice Address - Phone:218-236-5151
Practice Address - Fax:218-236-5866
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDPLA23303OtherBLUE CROSS BLUE SHIELD
MN554727000Medicaid
MN641S6PLOtherBLUE CROSS BLUE SHIELD
ND14209Medicaid
MNT66010Medicare UPIN
ND14209Medicaid