=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306157557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENSEN CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2010
-----------------------------------------------------
Last Update Date | 12/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1620 LOCUST ST SUITE 100
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64108-1418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-363-3500
-----------------------------------------------------
Fax | 816-363-3501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1620 LOCUST ST SUITE 100
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64108-1418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-363-3500
-----------------------------------------------------
Fax | 816-363-3501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. NATHAN DANIEL JENSEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 913-961-6004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2010015990
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------