Provider Demographics
NPI:1346782596
Name:CORE FAMILY CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:CORE FAMILY CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-751-5858
Mailing Address - Street 1:801 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4502
Mailing Address - Country:US
Mailing Address - Phone:701-751-5858
Mailing Address - Fax:
Practice Address - Street 1:801 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4502
Practice Address - Country:US
Practice Address - Phone:701-751-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty