Provider Demographics
NPI:1922075357
Name:NYHOLM-JENSEN, ELISABETTA G (DC)
Entity Type:Individual
Prefix:DR
First Name:ELISABETTA
Middle Name:G
Last Name:NYHOLM-JENSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:16060 N. 59TH AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-2338
Mailing Address - Country:US
Mailing Address - Phone:602-938-5522
Mailing Address - Fax:602-938-5068
Practice Address - Street 1:16060 N. 59TH AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-2338
Practice Address - Country:US
Practice Address - Phone:602-938-5522
Practice Address - Fax:602-938-5068
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ66447Medicare UPIN