Provider Demographics
NPI:1720031818
Name:JENSEN, TONY CLARK (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:CLARK
Last Name:JENSEN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W MOANA LN
Mailing Address - Street 2:STE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4902
Mailing Address - Country:US
Mailing Address - Phone:775-323-1222
Mailing Address - Fax:775-323-7002
Practice Address - Street 1:112 W MOANA LN
Practice Address - Street 2:STE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4902
Practice Address - Country:US
Practice Address - Phone:775-323-1222
Practice Address - Fax:775-323-7002
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00576111N00000X
CADC23163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVDC576Medicare PIN