Healthcare Provider Details

I. General information

NPI: 1508357765
Provider Name (Legal Business Name): JENSEN MOORE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MULBERRY DR STE C
SAN MARCOS CA
92069
US

IV. Provider business mailing address

878 WULFF ST
SAN MARCOS CA
92069-2135
US

V. Phone/Fax

Practice location:
  • Phone: 760-783-5514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: