Provider Demographics
NPI:1861528846
Name:KOLODJI, SEAN MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MITCHELL
Last Name:KOLODJI
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 1:1632 BEMIDJI AVE N
Mailing Address - Street 2:STE 1
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3870
Mailing Address - Country:US
Mailing Address - Phone:218-444-9918
Mailing Address - Fax:218-444-9784
Practice Address - Street 1:1632 BEMIDJI AVE N
Practice Address - Street 2:STE 1
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3870
Practice Address - Country:US
Practice Address - Phone:218-444-9918
Practice Address - Fax:218-444-9784
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410660100Medicaid
MNU98880Medicare UPIN
MN350003082Medicare ID - Type Unspecified