Provider Demographics
NPI:1154320851
Name:JENSEN, JORN TOFTEGAARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JORN
Middle Name:TOFTEGAARD
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 1:15951 LOS GATOS BLVD
Mailing Address - Street 2:STE 11A
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3428
Mailing Address - Country:US
Mailing Address - Phone:408-356-5800
Mailing Address - Fax:408-583-4078
Practice Address - Street 1:15951 LOS GATOS BLVD
Practice Address - Street 2:STE 11A
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3428
Practice Address - Country:US
Practice Address - Phone:408-356-5800
Practice Address - Fax:408-583-4078
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2008-01-22
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CADC23852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5631321OtherFIRST HEALTH, PROVIDER ID
CADC23852OtherBOARD OF EXAMINERS, LIC#
CADC0238520Medicare UPIN