Individual
DR. JACKIE LYNN JOHNSRUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
306 MAIN ST, WILLISTON, ND 58801-5304
(701) 580-4912
Mailing address
PO BOX 81, EPPING, ND 58843-0081
(701) 570-0119
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
865
ND
Other
Enumeration date
03/12/2012
Last updated
03/12/2012
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