Provider Demographics
NPI:1922156496
Name:JENSEN, RICHARD W (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
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 1:520 HIGHWAY 96 W
Mailing Address - Street 2:STE 200
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1962
Mailing Address - Country:US
Mailing Address - Phone:651-484-8521
Mailing Address - Fax:651-484-7374
Practice Address - Street 1:520 HIGHWAY 96 W
Practice Address - Street 2:STE 200
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1962
Practice Address - Country:US
Practice Address - Phone:651-484-8521
Practice Address - Fax:651-484-7374
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002387Medicare ID - Type Unspecified
MNU85303Medicare UPIN