Healthcare Provider Details

I. General information

NPI: 1891856829
Provider Name (Legal Business Name): DIXIE ANN JEPSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIXIE ANN JEPSON HOLLAND D.C.

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 LEXINGTON PARKWAY NORTH
SAINT PAUL MN
55104
US

IV. Provider business mailing address

786 LEXINGTON PARKWAY NORTH
SAINT PAUL MN
55104
US

V. Phone/Fax

Practice location:
  • Phone: 651-293-1897
  • Fax: 651-488-1182
Mailing address:
  • Phone: 651-293-1897
  • Fax: 651-488-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001559
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: