Provider Demographics
NPI:1326806472
Name:JENNIFER L. FOSS DC, PLLC
Entity Type:Organization
Organization Name:JENNIFER L. FOSS DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-321-2323
Mailing Address - Street 1:817 S MARION RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-0236
Mailing Address - Country:US
Mailing Address - Phone:605-362-8084
Mailing Address - Fax:605-323-1175
Practice Address - Street 1:817 S MARION RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-0236
Practice Address - Country:US
Practice Address - Phone:605-362-8084
Practice Address - Fax:605-323-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601540Medicaid