MEDICARE: JENNIFER CONNELL LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1127	MN

General Provider Information

NPI Number	:	1881850980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CONNELL LAC

Provider Business Mailing Address
First Line	:	2713 COLFAX AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-1262
Country	:	US
Telephone Number	:	612-824-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 DUPONT AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2700
Country	:	US
Telephone Number	:	612-824-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	01/17/2022

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Directions to “ JENNIFER CONNELL LAC” Practice Location

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