Provider Demographics
NPI:1134247976
Name:JENSEN CHIROPRACTIC CLINIC LTD
Entity type:Organization
Organization Name:JENSEN CHIROPRACTIC CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-626-0270
Mailing Address - Street 1:2002 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-3016
Mailing Address - Country:US
Mailing Address - Phone:815-626-0270
Mailing Address - Fax:815-626-0205
Practice Address - Street 1:2002 E 5TH ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-3016
Practice Address - Country:US
Practice Address - Phone:815-626-0270
Practice Address - Fax:815-626-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL942780Medicare ID - Type UnspecifiedGROUP NUMBER