Provider Demographics
NPI:1750512307
Name:ROUSSEAU, JENNIFER RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RENEE
Last Name:ROUSSEAU
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 1:664 SANGO RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5489
Mailing Address - Country:US
Mailing Address - Phone:931-368-1996
Mailing Address - Fax:931-368-0448
Practice Address - Street 1:664 SANGO RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5489
Practice Address - Country:US
Practice Address - Phone:931-368-1996
Practice Address - Fax:931-368-0448
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor