MEDICARE: CHIROPRACTIC 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	CHIA1244	ID

General Provider Information

NPI Number	:	1508093618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	228 HOLLY ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5104
Country	:	US
Telephone Number	:	208-467-5759
Fax Number	:	208-467-4510

Provider Business Practice Location Address
First Line	:	228 HOLLY ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5104
Country	:	US
Telephone Number	:	208-467-5759
Fax Number	:	208-467-4510

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JARED LEE JENSEN
Credential	:	D.C.
Telephone Number	:	208-467-5759

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/16/2009

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Directions to “CHIROPRACTIC CENTER ” Practice Location

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