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General NPI Number Information
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NPI Number | 1689759383
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Entity Type | Individual
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Provider Name | JENNIFER ELYSE PEDERSEN DC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 1131 JACKSON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3618
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Country | US
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Telephone | 218-844-5050
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Fax | 218-844-5049
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Provider Business Mailing Address
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Address Line | 1131 JACKSON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3618
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Country | US
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Telephone | 218-844-5050
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Fax | 218-844-5049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 575
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4079
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License Number State | MN
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