Provider Demographics
NPI:1154482487
Name:JENSEN FAMILY CHIROPRACTIC DC PC
Entity Type:Organization
Organization Name:JENSEN FAMILY CHIROPRACTIC DC PC
Other - Org Name:JENSEN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-743-2477
Mailing Address - Street 1:101 SW JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-1356
Mailing Address - Country:US
Mailing Address - Phone:641-743-2477
Mailing Address - Fax:
Practice Address - Street 1:101 SW JACKSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-1356
Practice Address - Country:US
Practice Address - Phone:641-743-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43684OtherWELLMARK BC BS NUMBER
IA43684OtherWELLMARK BC BS NUMBER