Provider Demographics
NPI:1376841031
Name:HORNBERGER, JASMINE LENA (DC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:LENA
Last Name:HORNBERGER
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 1:1428 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2392
Mailing Address - Country:US
Mailing Address - Phone:616-846-3860
Mailing Address - Fax:
Practice Address - Street 1:1428 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2392
Practice Address - Country:US
Practice Address - Phone:616-846-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C30350OtherBCBSM PIN