Provider Demographics
NPI:1851636716
Name:JESSEN, JAMES D (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:JESSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 VAN BUREN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2440
Mailing Address - Country:US
Mailing Address - Phone:608-343-3850
Mailing Address - Fax:
Practice Address - Street 1:1312 81ST AVE NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2116
Practice Address - Country:US
Practice Address - Phone:763-780-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor