Provider Demographics
NPI:1215382767
Name:WARREN, JESSICA (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:WARREN
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 1:801 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2337
Mailing Address - Country:US
Mailing Address - Phone:218-301-6074
Mailing Address - Fax:
Practice Address - Street 1:15170 CHIPPENDALE AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068
Practice Address - Country:US
Practice Address - Phone:651-423-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor