Provider Demographics
NPI:1013901677
Name:JENSEN, JAN ELKJAER (DC)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:ELKJAER
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 1:1844 FIDDLER CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4450
Mailing Address - Country:US
Mailing Address - Phone:850-222-2952
Mailing Address - Fax:850-222-2952
Practice Address - Street 1:1844 FIDDLER CT
Practice Address - Street 2:SUITE B
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4450
Practice Address - Country:US
Practice Address - Phone:850-222-2952
Practice Address - Fax:850-877-0845
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3809765-00Medicaid
FLT62322Medicare UPIN
FL88738Medicare ID - Type Unspecified