Provider Demographics
NPI:1265557854
Name:JENSEN, JENNIFER LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 UNIVERSITY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6200
Mailing Address - Country:US
Mailing Address - Phone:319-277-2745
Mailing Address - Fax:319-266-5176
Practice Address - Street 1:4728 UNIVERSITY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6200
Practice Address - Country:US
Practice Address - Phone:319-277-2745
Practice Address - Fax:319-266-5176
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2249326Medicaid
IA39438OtherBCBS
IA39438OtherBCBS
IA2249326Medicaid