Provider Demographics
NPI:1275626277
Name:RATHMANN JOHNSEN, JENNIFER (DC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:RATHMANN JOHNSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:RATHMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1901 S MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6628
Mailing Address - Country:US
Mailing Address - Phone:540-951-6900
Mailing Address - Fax:540-951-8900
Practice Address - Street 1:620 N MAIN ST
Practice Address - Street 2:SUITE 203 TUCK CHIROPRACTIC CLINIC
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-951-4357
Practice Address - Fax:540-951-1202
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V128T58Medicare ID - Type Unspecified
U79143Medicare UPIN