Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 6721 | MN |
N | 111N00000X | Chiropractor | CHI-CHI-LIC-4515 | MT |
N | 111NP0017X | Pediatric Chiropractor | 4515 | MT |
Y | 111NP0017X | Pediatric Chiropractor | 6721 | MN |
NPI | 1083159131 |
---|---|
Provider Name | Dr. Jennifer Marie Vine |
First Address | Hancock, MN 56244-1215 |
Second Address | Hancock, MN 56244-2104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2016 |
Last Update Date | 23/11/2021 |