Provider Demographics
NPI:1497935050
Name:JENSEN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:JENSEN CHIROPRACTIC INC
Other - Org Name:CORRECTIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-828-5669
Mailing Address - Street 1:401 N WEST ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1399
Mailing Address - Country:US
Mailing Address - Phone:919-828-5669
Mailing Address - Fax:919-828-5676
Practice Address - Street 1:401 N WEST ST
Practice Address - Street 2:SUITE 113
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1399
Practice Address - Country:US
Practice Address - Phone:919-828-5669
Practice Address - Fax:919-828-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU82715Medicare UPIN