Provider Demographics
NPI:1871918706
Name:JACOBSSON, KALEY (DC)
Entity type:Individual
Prefix:DR
First Name:KALEY
Middle Name:
Last Name:JACOBSSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KALEY
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:110 DIVISION ST E
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1525
Mailing Address - Country:US
Mailing Address - Phone:763-682-1471
Mailing Address - Fax:
Practice Address - Street 1:110 DIVISION ST E
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1525
Practice Address - Country:US
Practice Address - Phone:763-682-1471
Practice Address - Fax:763-682-7030
Is Sole Proprietor?:No
Enumeration Date:2014-03-01
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor