Provider Demographics
NPI:1639438922
Name:JM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:JM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-444-2070
Mailing Address - Street 1:705 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4838
Mailing Address - Country:US
Mailing Address - Phone:218-444-2070
Mailing Address - Fax:218-444-8091
Practice Address - Street 1:705 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4838
Practice Address - Country:US
Practice Address - Phone:218-444-2070
Practice Address - Fax:218-444-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty