Provider Demographics
NPI:1578621033
Name:BREMER, JANINE ALICE (DC)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:ALICE
Last Name:BREMER
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:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-0396
Mailing Address - Country:US
Mailing Address - Phone:507-376-9771
Mailing Address - Fax:507-376-9798
Practice Address - Street 1:1024 OXFORD ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1681
Practice Address - Country:US
Practice Address - Phone:507-376-9771
Practice Address - Fax:507-376-9798
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61964GRMedicare UPIN
MN35001538Medicare ID - Type Unspecified