Provider Demographics
NPI:1083159131
Name:VINE, JENNIFER MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:VINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:NOORDMANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39041 COUNTY ROAD 2
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56244-1215
Mailing Address - Country:US
Mailing Address - Phone:320-349-1650
Mailing Address - Fax:
Practice Address - Street 1:657 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MN
Practice Address - Zip Code:56244-2104
Practice Address - Country:US
Practice Address - Phone:320-349-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6721111N00000X, 111NP0017X
MTCHI-CHI-LIC-4515111N00000X
MT4515111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor