Provider Demographics
NPI:1720413792
Name:JENSEN CHIROPRACTIC AND WELLNESS PLLC
Entity Type:Organization
Organization Name:JENSEN CHIROPRACTIC AND WELLNESS PLLC
Other - Org Name:JENSEN CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-585-3000
Mailing Address - Street 1:533 S MIDDLETON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-6013
Mailing Address - Country:US
Mailing Address - Phone:208-585-3000
Mailing Address - Fax:208-585-2222
Practice Address - Street 1:533 S MIDDLETON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-6013
Practice Address - Country:US
Practice Address - Phone:208-585-3000
Practice Address - Fax:208-585-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty