Provider Demographics
NPI:1881876472
Name:SABOURIN, JENNIFER LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:SABOURIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1220 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2909
Mailing Address - Country:US
Mailing Address - Phone:218-233-1188
Mailing Address - Fax:218-287-1829
Practice Address - Street 1:1411 32ND ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6304
Practice Address - Country:US
Practice Address - Phone:701-232-2738
Practice Address - Fax:701-241-4175
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN719563OtherACN
MN76L01BEOtherBCBS MN
MN871622000Medicaid
MN350004042OtherMEDICARE PTAN
ND30608OtherBCBS ND