MEDICARE: JENNIFER LYNNE HASSELBROOK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	57433611202	UT

General Provider Information

NPI Number	:	1013118496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNNE HASSELBROOK D.C.

Provider Business Mailing Address
First Line	:	PO BOX 683544
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84068-3544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2078 PROSPECTOR AVE
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7321
Country	:	US
Telephone Number	:	435-615-7971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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