Provider Demographics
NPI:1407328677
Name:KING, JESSICA N S (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:N S
Last Name:KING
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 1:7600 BRISTOL VILLAGE DR APT 218
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-2592
Mailing Address - Country:US
Mailing Address - Phone:715-379-7323
Mailing Address - Fax:
Practice Address - Street 1:7801 E BUSH LAKE RD STE 280
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-3144
Practice Address - Country:US
Practice Address - Phone:952-800-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor