Provider Demographics
NPI:1043234990
Name:JENSEN, STEVEN DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DEAN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 CALLE PORTILLA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1862
Mailing Address - Country:US
Mailing Address - Phone:805-987-4375
Mailing Address - Fax:805-987-6869
Practice Address - Street 1:1000 PASEO CAMARILLO
Practice Address - Street 2:#118
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6021
Practice Address - Country:US
Practice Address - Phone:805-987-4375
Practice Address - Fax:805-987-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC17932AMedicare ID - Type Unspecified