Provider Demographics
NPI:1295012938
Name:LENSEGRAV, JESSE (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:LENSEGRAV
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 1:2866 CRESCENT AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7342
Mailing Address - Country:US
Mailing Address - Phone:541-654-5499
Mailing Address - Fax:
Practice Address - Street 1:2866 CRESCENT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7342
Practice Address - Country:US
Practice Address - Phone:541-654-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1194111N00000X
OR5013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor