Healthcare Provider Details

I. General information

NPI: 1386630978
Provider Name (Legal Business Name): DAVID JENSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 04/11/2006

III. Provider practice location address

2211 US HIGHWAY 169 N
ALGONA IA
50511-7219
US

IV. Provider business mailing address

2211 US HIGHWAY 169 N
ALGONA IA
50511-7219
US

V. Phone/Fax

Practice location:
  • Phone: 515-295-7744
  • Fax: 515-295-7370
Mailing address:
  • Phone: 515-295-7744
  • Fax: 515-295-7370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5046
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: