MEDICARE: JENSEN DIAGNOSTIC & TREATMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2952	TX

General Provider Information

NPI Number	:	1366453821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENSEN DIAGNOSTIC & TREATMENT CENTER

Provider Business Mailing Address
First Line	:	13714 GAMMA ROAD
Second Line	:	SUITE 125
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4485
Country	:	US
Telephone Number	:	972-243-5757
Fax Number	:	972-488-6988

Provider Business Practice Location Address
First Line	:	13714 GAMMA RD
Second Line	:	SUITE 125
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4474
Country	:	US
Telephone Number	:	972-243-5757
Fax Number	:	972-488-6988

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANDRA LEE JENSEN
Credential	:	D.C.
Telephone Number	:	972-243-5757

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	04/23/2008

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