Provider Demographics
NPI:1669847695
Name:STRUCK, JENNIFER KRISTINE (DC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISTINE
Last Name:STRUCK
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 1:107 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:50459-1332
Mailing Address - Country:US
Mailing Address - Phone:712-210-6473
Mailing Address - Fax:
Practice Address - Street 1:308 4TH AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3085
Practice Address - Country:US
Practice Address - Phone:507-437-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor