MEDICARE: DR. JAMES D JESSEN 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	5715	MN

General Provider Information

NPI Number	:	1851636716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES D JESSEN D.C.

Provider Business Mailing Address
First Line	:	9414 VAN BUREN ST NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55434-2440
Country	:	US
Telephone Number	:	608-343-3850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 81ST AVE NE
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2116
Country	:	US
Telephone Number	:	763-780-0112
Fax Number	:

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

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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