Healthcare Provider Details

I. General information

NPI: 1124420179
Provider Name (Legal Business Name): JENNA NIGGELER L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 KINGWOOD ST STE 119A
BRAINERD MN
56401
US

IV. Provider business mailing address

14713 INGLEWOOD DR
BAXTER MN
56425-8522
US

V. Phone/Fax

Practice location:
  • Phone: 218-831-9190
  • Fax:
Mailing address:
  • Phone: 218-831-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1746
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: