Provider Demographics
NPI:1063645463
Name:JENSEN, MATTHEW OLAF (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:OLAF
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 1:6215 PHINNEY AVE N APT 106
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5500
Mailing Address - Country:US
Mailing Address - Phone:206-779-8547
Mailing Address - Fax:
Practice Address - Street 1:801 S 3RD ST STE D
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2799
Practice Address - Country:US
Practice Address - Phone:425-226-2821
Practice Address - Fax:206-202-2611
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60153882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor