Healthcare Provider Details

I. General information

NPI: 1679699862
Provider Name (Legal Business Name): JENSON CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 8TH ST
MONROE WI
53566-1068
US

IV. Provider business mailing address

718 8TH ST
MONROE WI
53566-1068
US

V. Phone/Fax

Practice location:
  • Phone: 608-293-0478
  • Fax: 608-325-1489
Mailing address:
  • Phone: 608-293-0478
  • Fax: 608-325-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number4146-012
License Number StateWI

VIII. Authorized Official

Name: DR. KELLY JO JENSON
Title or Position: OWNER
Credential: DC
Phone: 608-293-0478