Provider Demographics
NPI:1982611778
Name:JENSEN, ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
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 1:921 S ORCHARD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1930
Mailing Address - Country:US
Mailing Address - Phone:208-426-9100
Mailing Address - Fax:208-426-9104
Practice Address - Street 1:921 S ORCHARD ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1930
Practice Address - Country:US
Practice Address - Phone:208-426-9100
Practice Address - Fax:208-426-9104
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCHIA-950OtherIDAHO LICENSE
IDCHIA-950OtherIDAHO LICENSE
ID1675667Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER