MR. JEFFREY KOROLCHUK JR. (NPI# 1164883765) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164883765 |
| Entity Type | Individual |
| Full Name | MR. JEFFREY KOROLCHUK JR. |
| Credential | L.M.T. |
| Practice Address |
2204 Lexington Ave N Apt 10 Roseville MN 55113-4355 |
| Practice Telephone | 6125789260 |
| Mailing Telephone | 6125789260 |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2016-03-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
2204 LEXINGTON AVE N APT 10 |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113-4355 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1699251520 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2685 Patton Rd, Roseville, MN 55113 | 2018-07-13 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| Find all providers in zip 55113 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838747 | Quinn Morse | Massage Therapist | 1058 Shenencock Way, Roseville, CA 95747-7512 | 2020-10-15 |
| 1093322190 | Steven Gonzalez Rodriguez | Massage Therapist | 701 Gibson Dr Apt 1612, Roseville, CA 95678-5744 | 2020-09-23 |
| 1164036885 | Emanuel Buggs | Massage Therapist | 30585 Sandhurst Dr Apt 205, Roseville, MI 48066-7724 | 2020-09-01 |
| 1326695495 | Jordan Wan | Massage Therapist | 1141 Smith Lane Ste #3, Ste #3, Roseville, OH 95661-4123 | 2019-08-22 |
| 1124593538 | Dean Samuel Pastor | Massage Therapist | 6001 Barnside Pl, Roseville, CA 95747-9616 | 2018-10-11 |
| 1184103392 | Jennifer Youssef | Massage Therapist | 18001 Biehl St, Roseville, MI 48066-2573 | 2018-08-08 |
| 1760911192 | Laura Marie Hummel | Massage Therapist | 9077 Foothills Blvd. Suite 200, Roseville, CA 95747 | 2017-06-08 |
| 1215479613 | Melonie Jackson | Massage Therapist | 26640 Belanger St, Roseville, MI 48066-3185 | 2016-11-16 |
| 1982073193 | Sherri Macmillan | Massage Therapist | 508 Gibson Drive, Ste 290, Roseville, CA 95678 | 2015-09-17 |
| 1215322417 | Lisa Thompson | Massage Therapist | 2353 Rice St Ste 130, Roseville, MN 55113-3770 | 2015-04-03 |
| Find all providers in ROSEVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.