Provider Demographics
NPI:1619017902
Name:JORGENSON, JAMES BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BENJAMIN
Last Name:JORGENSON
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 1:307 WELLER ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1942
Mailing Address - Country:US
Mailing Address - Phone:660-385-5326
Mailing Address - Fax:660-385-7696
Practice Address - Street 1:307 WELLER ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1942
Practice Address - Country:US
Practice Address - Phone:660-385-5326
Practice Address - Fax:660-385-7696
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO288914OtherHEALTHLINK
MO4586OtherBLUE CROSS BLUE SHIELD
MO288914OtherHEALTHLINK