Provider Demographics
NPI:1568690972
Name:JENSEN, ROSS ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ALLAN
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 1:3525 E CALUMET ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4167
Mailing Address - Country:US
Mailing Address - Phone:920-733-7888
Mailing Address - Fax:920-733-7881
Practice Address - Street 1:3525 E CALUMET ST
Practice Address - Street 2:SUITE 600
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4167
Practice Address - Country:US
Practice Address - Phone:920-733-7888
Practice Address - Fax:920-733-7881
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4508-012111N00000X
MO2009014144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor