Provider Demographics
NPI:1417013178
Name:JENSEN, PAUL G (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:JENSEN
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 1:196 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2631
Mailing Address - Country:US
Mailing Address - Phone:801-785-9115
Mailing Address - Fax:801-785-9195
Practice Address - Street 1:196 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2631
Practice Address - Country:US
Practice Address - Phone:801-785-9115
Practice Address - Fax:801-785-9195
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT170947-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78073Medicare UPIN