Provider Demographics
NPI:1679656292
Name:EBBERS, ALAN JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:JOSEPH
Last Name:EBBERS
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 1:1820 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-1866
Mailing Address - Country:US
Mailing Address - Phone:507-372-4400
Mailing Address - Fax:507-376-4624
Practice Address - Street 1:1820 OXFORD ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1866
Practice Address - Country:US
Practice Address - Phone:507-372-4400
Practice Address - Fax:507-376-4624
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN852728800Medicaid
MNP93685Medicare UPIN
MN359000698Medicare ID - Type Unspecified