Provider Demographics
NPI:1366047151
Name:KREBSBACH, MELISSA LEE JACOBS (DC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE JACOBS
Last Name:KREBSBACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 DEERWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3644
Mailing Address - Country:US
Mailing Address - Phone:320-309-2460
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR STE 235
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1716
Practice Address - Country:US
Practice Address - Phone:763-400-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor