Provider Demographics
NPI:1649288564
Name:JENSEN, STANLEY DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:DAVID
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 1:3687 E LAS POSAS ROAD
Mailing Address - Street 2:STE 185
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-484-1990
Mailing Address - Fax:805-388-8773
Practice Address - Street 1:3687 E LAS POSAS ROAD
Practice Address - Street 2:STE 185
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-484-1990
Practice Address - Fax:805-388-8773
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0114510Medicare ID - Type Unspecified
T04347Medicare UPIN