Jenna Lynn Dougherty, DC
Individual provider Active NPI Chiropractor · Hermantown, MN
NPI 1336849587 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1336849587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 7081 (MN)
- Practice address
- 5094 Miller Trunk Hwy Ste 300
Hermantown, MN 55811-1637 - Phone
- (218) 729-7077
- NPI assigned
- Mar 7, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
- Group practices
- True North Spinal Care PLLC
Practice addresses (Care Compare)
5094 Miller Trunk Hwy
Suite 300
Hermantown, MN 55811-1637
Phone (218) 729-7077
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230413001726 | MN | Practitioner - Chiropractic | 6305211921 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7081 | MN | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| True North Spinal Care, PLLC | Chiropractor | Current |
Accepting new patients |
Locations
5094 Miller Trunk Hwy
Ste 300
Hermantown, MN 55811
Phone (218) 729-7077
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 7081 | MN | Yes |
Addresses
Primary practice location
5094 Miller Trunk Hwy Ste 300
Hermantown, MN 55811-1637
Mailing address
5094 Miller Trunk Hwy Ste 300
Hermantown, MN 55811-1637
Phone (218) 729-7077
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992193825 | Other | MN | NPPES |
Other providers in Hermantown, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.