Provider Demographics
NPI:1346532835
Name:JORGENSEN PROF CORP
Entity Type:Organization
Organization Name:JORGENSEN PROF CORP
Other - Org Name:NORTHWEST INJURY CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-736-2225
Mailing Address - Street 1:512 N YOUNG ST STE C
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7839
Mailing Address - Country:US
Mailing Address - Phone:509-736-2225
Mailing Address - Fax:509-736-3366
Practice Address - Street 1:512 N YOUNG ST STE C
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7839
Practice Address - Country:US
Practice Address - Phone:509-736-2225
Practice Address - Fax:509-736-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty