Provider Demographics
NPI:1508318023
Name:OTREMBA, JOLENE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:
Last Name:OTREMBA
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 1:201 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-1832
Mailing Address - Country:US
Mailing Address - Phone:952-758-5135
Mailing Address - Fax:952-758-5179
Practice Address - Street 1:201 MAIN ST E
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-1832
Practice Address - Country:US
Practice Address - Phone:952-758-5135
Practice Address - Fax:952-758-5179
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor