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Individual
DR. JENNIFER ELYSE PEDERSEN
Active
Individual
DR. JENNIFER ELYSE PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4079
MN
171100000X
Acupuncturist
575
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020960100
MHCP HEALTH CARE
—
05
—
020960100
—
MN
01
—
0908
HSM
—
01
—
134208196
EMPLOYER # FED #
—
01
—
242T6NO
CLINIC #
—
01
—
242T7PE
BCBS PROVIDER #
—
01
—
350002650
MEDICARE PROVIDER #
—
01
—
4079
LICENSE #
—
01
—
575
ACCUPUNCTURE #
—
01
—
647163
CHIROCARE #
—
01
—
89749
HEALTH PARTNERS
—
01
—
P00229402
RAILROAD
—
Enumeration date
10/25/2006
Last updated
09/13/2023
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