Provider Demographics
NPI:1053863464
Name:JABS, ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:JABS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:SKOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:876 SELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6529
Mailing Address - Country:US
Mailing Address - Phone:952-201-3420
Mailing Address - Fax:
Practice Address - Street 1:876 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6529
Practice Address - Country:US
Practice Address - Phone:952-201-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor