Provider Demographics
NPI:1164700803
Name:MINNICH, JENNIFER MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:MINNICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6360 TYLERSVILLE RD
Mailing Address - Street 2:G
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1210
Mailing Address - Country:US
Mailing Address - Phone:513-770-0553
Mailing Address - Fax:513-770-0773
Practice Address - Street 1:6360 TYLERSVILLE RD
Practice Address - Street 2:G
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1210
Practice Address - Country:US
Practice Address - Phone:513-770-0553
Practice Address - Fax:513-770-0773
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor