Provider Demographics
NPI:1023693975
Name:JENSEN, WADE ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:WADE
Middle Name:ALEXANDER
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 1:7240 BODEGA PT APT 1733
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-6916
Mailing Address - Country:US
Mailing Address - Phone:402-206-6724
Mailing Address - Fax:
Practice Address - Street 1:2610 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4417
Practice Address - Country:US
Practice Address - Phone:308-236-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor