1518942580 NPI number — DR. JENNIFER LYNN ESSELMAN D.C.

Table of content: DR. JENNIFER LYNN ESSELMAN D.C. (NPI 1518942580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518942580 NPI number — DR. JENNIFER LYNN ESSELMAN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESSELMAN
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESPESETH
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518942580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9125 QUADAY AVE NE
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
OTSEGO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55330-6662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-274-0373
Provider Business Mailing Address Fax Number:
763-274-0375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9125 QUADAY AVE NE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
OTSEGO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55330-6662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-274-0373
Provider Business Practice Location Address Fax Number:
763-274-0375
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4280 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 350003555 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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