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NPI Code Detail

MEDICARE: DR. ELISABETTA G NYHOLM-JENSEN D.C.

MEDICARE: DR. ELISABETTA G NYHOLM-JENSEN D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3719AZ

General Provider Information

NPI Number : 1922075357
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELISABETTA G NYHOLM-JENSEN D.C.
Provider Business Mailing Address
First Line : 16060 N. 59TH AVENUE
Second Line : SUITE 2
City : GLENDALE
State : AZ
Zip : 85306-2338
Country : US
Telephone Number : 602-938-5522
Fax Number : 602-938-5068
Provider Business Practice Location Address
First Line : 16060 N. 59TH AVENUE
Second Line : SUITE 2
City : GLENDALE
State : AZ
Zip : 85306-2338
Country : US
Telephone Number : 602-938-5522
Fax Number : 602-938-5068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2006
Last Update Date : 09/27/2013

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