Provider Demographics
NPI:1932435666
Name:DEMAIO, JENNIFER (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DEMAIO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 CENTER AVE
Mailing Address - Street 2:STE K
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2080
Mailing Address - Country:US
Mailing Address - Phone:218-287-4501
Mailing Address - Fax:701-660-1052
Practice Address - Street 1:1001 CENTER AVE
Practice Address - Street 2:STE K
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2080
Practice Address - Country:US
Practice Address - Phone:218-287-4501
Practice Address - Fax:701-660-1052
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist