Healthcare Provider Details

I. General information

NPI: 1760527287
Provider Name (Legal Business Name): JENNIFER LYNN TONNESON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21080 OLINDA TRL N BOX 4
SCANDIA MN
55073-9492
US

IV. Provider business mailing address

21080 OLINDA TRL N BOX 4
SCANDIA MN
55073-9492
US

V. Phone/Fax

Practice location:
  • Phone: 651-433-5750
  • Fax: 651-433-5750
Mailing address:
  • Phone: 651-433-5750
  • Fax: 651-433-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4738
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: