Provider Demographics
NPI:1619037439
Name:PERSON, JENNIFER ANN (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:PERSON
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 1:15574 EDGEWOOD DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-6955
Mailing Address - Country:US
Mailing Address - Phone:218-829-2665
Mailing Address - Fax:218-829-4855
Practice Address - Street 1:15574 EDGEWOOD DR
Practice Address - Street 2:SUITE #102
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-6955
Practice Address - Country:US
Practice Address - Phone:218-829-2665
Practice Address - Fax:218-829-4855
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor