MEDICARE: DR. JAMES BENJAMIN JORGENSON D.C.

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	6109	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	288914	OTHER	MO	HEALTHLINK
2	4586	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1619017902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES BENJAMIN JORGENSON D.C.

Provider Business Mailing Address
First Line	:	307 WELLER ST
Second Line	:
City	:	MACON
State	:	MO
Zip	:	63552-1942
Country	:	US
Telephone Number	:	660-385-5326
Fax Number	:	660-385-7696

Provider Business Practice Location Address
First Line	:	307 WELLER ST
Second Line	:
City	:	MACON
State	:	MO
Zip	:	63552-1942
Country	:	US
Telephone Number	:	660-385-5326
Fax Number	:	660-385-7696

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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