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General NPI Number Information
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NPI Number | 1063645463
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Entity Type | Individual
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Provider Name | MATTHEW OLAF JENSEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 801 S 3RD ST STE D
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City | RENTON
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State | WA
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Zip | 98057-2799
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Country | US
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Telephone | 425-226-2821
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Fax | 206-202-2611
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Provider Business Mailing Address
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Address Line | 6215 PHINNEY AVE N APT 106
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City | SEATTLE
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State | WA
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Zip | 98103-5500
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Country | US
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Telephone | 206-779-8547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 60153882
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License Number State | WA
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