Provider Demographics
NPI:1033198635
Name:FOSS, JENNIFER L (DC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:FOSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 S MARION RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-0236
Mailing Address - Country:US
Mailing Address - Phone:605-362-8084
Mailing Address - Fax:605-323-1175
Practice Address - Street 1:817 S MARION RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-0236
Practice Address - Country:US
Practice Address - Phone:605-362-8084
Practice Address - Fax:605-323-1175
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601540Medicaid
SD7601540Medicaid