Provider Demographics
NPI:1225245087
Name:FENSKE, JASON MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:FENSKE
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 1:9201 LA RIVIER CT
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2545
Mailing Address - Country:US
Mailing Address - Phone:763-541-1280
Mailing Address - Fax:763-541-1012
Practice Address - Street 1:5801 DULUTH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3958
Practice Address - Country:US
Practice Address - Phone:763-541-1280
Practice Address - Fax:763-541-1012
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor