Healthcare Provider Details

I. General information

NPI: 1396422192
Provider Name (Legal Business Name): JENSEN CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 EUREKA WAY # B
REDDING CA
96001-0816
US

IV. Provider business mailing address

1115 EUREKA WAY # B
REDDING CA
96001-0816
US

V. Phone/Fax

Practice location:
  • Phone: 530-515-9176
  • Fax: 530-241-2798
Mailing address:
  • Phone: 530-241-2798
  • Fax: 530-241-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JENS OLE JENSEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DC
Phone: 530-241-2798