Provider Demographics
NPI:1104823053
Name:LING, JESSICA MARON (DC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARON
Last Name:LING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:MARON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:21782 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55320-4556
Mailing Address - Country:US
Mailing Address - Phone:320-761-9350
Mailing Address - Fax:320-251-4763
Practice Address - Street 1:21782 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:MN
Practice Address - Zip Code:55320-4556
Practice Address - Country:US
Practice Address - Phone:320-761-9350
Practice Address - Fax:320-251-4763
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN314L3LIOtherBCBS
MN981501500Medicaid
V00055Medicare UPIN
MN981501500Medicaid