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General NPI Number Information
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NPI Number | 1437617149
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Entity Type | Individual
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Provider Name | JORDAN RICHARD JENSEN DC
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Gender | Male
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 1802 E 50TH ST UNIT 112
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City | LUBBOCK
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State | TX
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Zip | 79404-4006
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Country | US
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Telephone | 806-747-2735
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Fax |
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Provider Business Mailing Address
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Address Line | 7414 ELGIN AVE APT 8C
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City | LUBBOCK
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State | TX
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Zip | 79423-1402
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Country | US
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Telephone | 334-663-2258
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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 | 13997
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License Number State | TX
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