Provider Demographics
NPI:1033730890
Name:DORN, JENNIFER ASHLY (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ASHLY
Last Name:DORN
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 1:603 ROUNDHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1891
Mailing Address - Country:US
Mailing Address - Phone:612-720-3902
Mailing Address - Fax:
Practice Address - Street 1:1755 17TH AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3372
Practice Address - Country:US
Practice Address - Phone:952-445-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor