Provider Demographics
NPI:1245255173
Name:NYHOLM-JENSEN, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:NYHOLM-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 1:6770 W. DEER VALLEY RD.
Mailing Address - Street 2:SUITE B102
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5957
Mailing Address - Country:US
Mailing Address - Phone:623-566-8975
Mailing Address - Fax:623-566-9764
Practice Address - Street 1:6770 W DEER VALLEY RD
Practice Address - Street 2:B102
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5957
Practice Address - Country:US
Practice Address - Phone:602-694-7929
Practice Address - Fax:623-566-9764
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ200003291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ116100Medicare PIN