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General NPI Number Information
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NPI Number | 1720413792
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Entity Type | Organization
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Legal Business Name | JENSEN CHIROPRACTIC AND WELLNESS PLLC
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 533 S MIDDLETON RD SUITE 102
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City | MIDDLETON
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State | ID
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Zip | 83644-6013
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Country | US
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Telephone | 208-585-3000
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Fax | 208-585-2222
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Provider Business Mailing Address
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Address Line | 533 S MIDDLETON RD SUITE 102
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City | MIDDLETON
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State | ID
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Zip | 83644-6013
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Country | US
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Telephone | 208-585-3000
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Fax | 208-585-2222
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. KENNETH DEAN JENSEN
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Credential | D.C.
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Telephone | 208-585-3000
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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 | CHIA1565
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License Number State | ID
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