Provider Demographics
NPI:1437617149
Name:JENSEN, JORDAN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:RICHARD
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 1:7414 ELGIN AVE APT 8C
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1402
Mailing Address - Country:US
Mailing Address - Phone:334-663-2258
Mailing Address - Fax:
Practice Address - Street 1:1802 E 50TH ST UNIT 112
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-4006
Practice Address - Country:US
Practice Address - Phone:806-747-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1437617149Medicaid