Healthcare Provider Details

I. General information

NPI: 1215382767
Provider Name (Legal Business Name): JESSICA WARREN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 CITY WALK DR APT F
WOODBURY MN
55129-9270
US

IV. Provider business mailing address

801 NW 9TH ST
GRAND RAPIDS MN
55744-2337
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-6830
  • Fax:
Mailing address:
  • Phone: 218-301-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6217
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: