Provider Demographics
NPI:1669764783
Name:SKOUG, JESSIN LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JESSIN
Middle Name:LYNN
Last Name:SKOUG
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 1:131 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1236
Mailing Address - Country:US
Mailing Address - Phone:651-565-4863
Mailing Address - Fax:651-565-4893
Practice Address - Street 1:131 MAIN ST W
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1236
Practice Address - Country:US
Practice Address - Phone:651-565-4863
Practice Address - Fax:651-565-4893
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5533111N00000X
WI4754-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor