Provider Demographics
NPI:1649329749
Name:JAKUBOWSKI, LUKE MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:MATTHEW
Last Name:JAKUBOWSKI
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 1:11689 MILLPOND AVE
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 SILVER BELL RD
Practice Address - Street 2:SUITE #2
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1050
Practice Address - Country:US
Practice Address - Phone:651-233-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4802111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician