Provider Demographics
NPI:1730238304
Name:HAMMES, JILL REBEKAH (DC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:REBEKAH
Last Name:HAMMES
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 1:10438 185TH ST W STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5307
Mailing Address - Country:US
Mailing Address - Phone:952-898-0525
Mailing Address - Fax:952-898-0935
Practice Address - Street 1:10438 185TH ST W STE 200
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5307
Practice Address - Country:US
Practice Address - Phone:952-898-0525
Practice Address - Fax:952-898-0935
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN923120000Medicaid
MN923120000Medicaid