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General NPI Number Information
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NPI Number | 1275864746
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Entity Type | Individual
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Provider Name | JEFFREY SIMON JENSEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2010
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 2464 W 12600 S SUITE 110
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City | RIVERTON
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State | UT
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Zip | 84065-7274
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Country | US
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Telephone | 801-477-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 2464 W 12600 S SUITE 110
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City | RIVERTON
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State | UT
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Zip | 84065-7274
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Country | US
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Telephone | 801-477-7222
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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 | CHIA1400
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7978681-1202
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License Number State | UT
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