Provider Demographics
NPI:1851497747
Name:JENSEN, FREDERICK LIN II (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LIN
Last Name:JENSEN
Suffix:II
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 1:712 W MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-9403
Mailing Address - Country:US
Mailing Address - Phone:317-837-7875
Mailing Address - Fax:317-837-7930
Practice Address - Street 1:712 W MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-9403
Practice Address - Country:US
Practice Address - Phone:317-837-7875
Practice Address - Fax:317-837-7930
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002148A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2013132541Medicare UPIN
IN9357313Medicare UPIN
IN342247Medicare UPIN
IN7184621Medicare UPIN
IN219560AMedicare ID - Type UnspecifiedGROUP
IN219560Medicare ID - Type UnspecifiedINDIVIDUAL
IN667991Medicare UPIN