Provider Demographics
NPI:1275519522
Name:EICHMAN, JENNIFER B (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:EICHMAN
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 1:601 E SANBORN ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4365
Mailing Address - Country:US
Mailing Address - Phone:507-474-1530
Mailing Address - Fax:
Practice Address - Street 1:601 E SANBORN ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4365
Practice Address - Country:US
Practice Address - Phone:507-474-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4508111N00000X
WI4019-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN315K0EIOtherBLUE CROSS BLUE SHIELD ID
MN438049500Medicaid
WI38951500Medicaid
MN438049500Medicaid
MNV00026Medicare UPIN