Healthcare Provider Details

I. General information

NPI: 1801025044
Provider Name (Legal Business Name): LYNNSEY NICOLE JEPSEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13635 NORTHDALE BLVD
ROGERS MN
55374-2142
US

IV. Provider business mailing address

13635 NORTHWOOD BLVD
ROGERS MN
55374-0660
US

V. Phone/Fax

Practice location:
  • Phone: 612-968-7200
  • Fax:
Mailing address:
  • Phone: 763-428-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5238
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: