Provider Demographics
NPI:1902044852
Name:BLAIR, JENNIFER C (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 28TH ST.
Mailing Address - Street 2:MAIL ROUTE 15115, INSTITUTE FOR HEALTH AND HEALING
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3799
Mailing Address - Country:US
Mailing Address - Phone:612-863-3333
Mailing Address - Fax:612-863-9019
Practice Address - Street 1:800 E 28TH ST.
Practice Address - Street 2:MAIL ROUTE 15115, INSTITUTE FOR HEALTH AND HEALING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3799
Practice Address - Country:US
Practice Address - Phone:612-863-3333
Practice Address - Fax:612-863-9019
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1120171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1120OtherMINNESOTA BOARD OF MEDICAL PRACTICE ACUPUNCTURE LICENSE NUMBER