MEDICARE: DR. JERED ANTHONY JORGENSEN DC

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	1552	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00678769	OTHER	NE	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27233	OTHER	NE	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366689119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERED ANTHONY JORGENSEN DC

Provider Business Mailing Address
First Line	:	110 S SHERMAN AVE
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-4913
Country	:	US
Telephone Number	:	308-534-1870
Fax Number	:	308-534-1871

Provider Business Practice Location Address
First Line	:	110 S SHERMAN AVE
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-4913
Country	:	US
Telephone Number	:	308-534-1870
Fax Number	:	308-534-1871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	05/04/2022

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Directions to “ DR. JERED ANTHONY JORGENSEN DC” Practice Location

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