Provider Demographics
NPI:1922271816
Name:JORGENSEN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:JORGENSEN CHIROPRACTIC PC
Other - Org Name:FAMILY CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-233-9087
Mailing Address - Street 1:2629 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8624
Mailing Address - Country:US
Mailing Address - Phone:515-233-9087
Mailing Address - Fax:515-233-6409
Practice Address - Street 1:2629 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8624
Practice Address - Country:US
Practice Address - Phone:515-233-9087
Practice Address - Fax:515-233-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0451641Medicaid
IAI14240OtherIOWA MEDICARE INDIVIDUAL
IA0451658Medicaid
IA37766OtherWELLMARK BCBS
IAI14240Medicare PIN
I14239Medicare PIN