Healthcare Provider Details

I. General information

NPI: 1790510162
Provider Name (Legal Business Name): JEPSEN CHIROPRACTIC WELLNESS CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 RADIO RD STE 110
NAPLES FL
34104-3741
US

IV. Provider business mailing address

3960 RADIO RD STE 110
NAPLES FL
34104-3741
US

V. Phone/Fax

Practice location:
  • Phone: 239-465-0656
  • Fax:
Mailing address:
  • Phone: 239-465-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW DAVID JEPSEN
Title or Position: TREASURER
Credential: DC
Phone: 239-465-0656