Provider Demographics
NPI:1538384060
Name:HARDER, JOHN LESLIE (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LESLIE
Last Name:HARDER
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 1:1221 4TH AVE E
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1681
Mailing Address - Country:US
Mailing Address - Phone:952-445-0679
Mailing Address - Fax:952-445-6979
Practice Address - Street 1:1221 4TH AVE E
Practice Address - Street 2:SUITE 120
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1681
Practice Address - Country:US
Practice Address - Phone:952-445-0679
Practice Address - Fax:952-445-6979
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C223FAOtherBCBS PROVIDER CLINIC NO.
MN4C765HAOtherBCBS INDIV. PROVIDER NO.
MN053537Medicaid