Provider Demographics
NPI:1891847158
Name:JENSEN, MARK STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
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 1:1008 CAMINO SAN ACACIO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5955
Mailing Address - Country:US
Mailing Address - Phone:505-989-8505
Mailing Address - Fax:
Practice Address - Street 1:1008 CAMINO SAN ACACIO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5955
Practice Address - Country:US
Practice Address - Phone:505-989-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor