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General NPI Number Information
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NPI Number | 1689824344
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Entity Type | Individual
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Provider Name | ANDREW WILLIAM JENISON DC
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Gender | Male
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 4600 KIETZKE LN STE M249
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City | RENO
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State | NV
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Zip | 89502-5000
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Country | US
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Telephone | 775-825-3625
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Fax | 775-825-3628
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Provider Business Mailing Address
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Address Line | 4600 KIETZKE LN STE M249
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City | RENO
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State | NV
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Zip | 89502-5000
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Country | US
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Telephone | 775-825-3625
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Fax | 775-825-3628
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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 | BO1357
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License Number State | NV
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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 | 11944
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License Number State | CA
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