Provider Demographics
NPI:1679681068
Name:JENSEN, STEPHEN ANDERS (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANDERS
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 1:7 MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2758
Mailing Address - Country:US
Mailing Address - Phone:978-658-7590
Mailing Address - Fax:978-658-7594
Practice Address - Street 1:7 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2758
Practice Address - Country:US
Practice Address - Phone:978-658-7590
Practice Address - Fax:978-658-7594
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1956111N00000X
NH615-1100111N00000X
NYX007950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1612735Medicaid
MA1612735Medicaid
MAU64593Medicare UPIN