Provider Demographics
NPI:1669672200
Name:IVERSON, JILL PATRICIA (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:PATRICIA
Last Name:IVERSON
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 1:1304 W LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-4818
Mailing Address - Country:US
Mailing Address - Phone:218-998-2881
Mailing Address - Fax:218-998-2882
Practice Address - Street 1:1304 W LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-4818
Practice Address - Country:US
Practice Address - Phone:218-998-2881
Practice Address - Fax:218-998-2882
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor