Provider Demographics
NPI:1427173285
Name:ROBIDEAU, JENNIFER ELIZABETH (DC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:ROBIDEAU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1325 WEST LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1101
Mailing Address - Country:US
Mailing Address - Phone:320-523-1253
Mailing Address - Fax:320-523-1572
Practice Address - Street 1:1325 WEST LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1101
Practice Address - Country:US
Practice Address - Phone:320-523-1253
Practice Address - Fax:320-523-1572
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95770Medicare UPIN