Provider Demographics
NPI:1871664474
Name:KORGAARD, JENS ANTONI (DC)
Entity Type:Individual
Prefix:DR
First Name:JENS
Middle Name:ANTONI
Last Name:KORGAARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3038
Mailing Address - Country:US
Mailing Address - Phone:860-667-4722
Mailing Address - Fax:860-667-1022
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3038
Practice Address - Country:US
Practice Address - Phone:860-667-4722
Practice Address - Fax:860-667-1022
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor