Blake R Dejong

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6850 Issued in MN

Practice address

14675 Martin Dr Ste 100
Eden Prairie, MN 55344-2016

Phone

(952) 797-3045

NPI assigned

Mar 4, 2022

Last updated

Mar 4, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dejong Clinic PLLC

  dba Elite Spine Chiropractic

  • Chiropractor
  • Eden Prairie, MN
  • NPI 1932856457
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646352000000",
    "number": "1689321101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14675 MARTIN DR STE 100",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442016",
            "telephone_number": "952-797-3045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14675 MARTIN DR STE 100",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442016",
            "telephone_number": "952-797-3045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG",
        "first_name": "BLAKE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-04",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodore James Dean, PA STUDENT
• Babesh Debnath
• Paul C Deglmann
• Peter John Dehnel, M.D.
• Dejong Clinic PLLC (Elite Spine Chiropractic)
• Abdimalik Ahmed Dekow
• Abdirizack Ahmed Dekow
• Joseph Marion Delallo, PHARMD
• Josser E Delgado, M.D.
• Erica Ann Delles, LPCC

• Chiropractor in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.