Provider Demographics
NPI:1841349958
Name:JENSEN, KEITH N (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:N
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 1:1600 HIGHWAY 287 N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8853
Mailing Address - Country:US
Mailing Address - Phone:817-477-2907
Mailing Address - Fax:817-473-3507
Practice Address - Street 1:1600 HIGHWAY 287 N
Practice Address - Street 2:SUITE 102
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8853
Practice Address - Country:US
Practice Address - Phone:817-477-2907
Practice Address - Fax:817-473-3507
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7012TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G8690OtherBLUE CROSS BLUE SHIELD TX
TX8G8690OtherBLUE CROSS BLUE SHIELD TX
TXPENDINGMedicare ID - Type Unspecified