Provider Demographics
NPI:1669925160
Name:JDCI EQUITIES
Entity type:Organization
Organization Name:JDCI EQUITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-940-5831
Mailing Address - Street 1:507 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-3517
Mailing Address - Country:US
Mailing Address - Phone:507-837-2033
Mailing Address - Fax:507-698-0100
Practice Address - Street 1:507 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-3517
Practice Address - Country:US
Practice Address - Phone:507-837-2033
Practice Address - Fax:507-698-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303163251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management