Provider Demographics
NPI:1275888778
Name:HAAS, JENNIFER ANN (DC, MSHS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:HAAS
Suffix:
Gender:F
Credentials:DC, MSHS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, MSHS
Mailing Address - Street 1:123 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54768-1005
Mailing Address - Country:US
Mailing Address - Phone:715-644-5677
Mailing Address - Fax:715-644-3422
Practice Address - Street 1:123 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:WI
Practice Address - Zip Code:54768-1005
Practice Address - Country:US
Practice Address - Phone:715-644-5677
Practice Address - Fax:715-644-3422
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI487012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor