Provider Demographics
NPI:1265773519
Name:SMABY, JENNA RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:RENEE
Last Name:SMABY
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 1:2860 10TH AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2275
Mailing Address - Country:US
Mailing Address - Phone:701-757-1145
Mailing Address - Fax:701-757-1556
Practice Address - Street 1:2860 10TH AVE N STE 200
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2275
Practice Address - Country:US
Practice Address - Phone:701-757-1145
Practice Address - Fax:701-757-1556
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5354111N00000X
ND1067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor