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General NPI Number Information
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NPI Number | 1508093618
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 228 HOLLY ST
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City | NAMPA
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State | ID
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Zip | 83686-5104
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Country | US
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Telephone | 208-467-5759
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Fax | 208-467-4510
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Provider Business Mailing Address
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Address Line | 228 HOLLY ST
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City | NAMPA
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State | ID
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Zip | 83686-5104
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Country | US
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Telephone | 208-467-5759
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Fax | 208-467-4510
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Authorized Official
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Title or Position | OWNER
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Name | DR. JARED LEE JENSEN
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Credential | D.C.
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Telephone | 208-467-5759
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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 | CHIA1244
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License Number State | ID
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