Provider Demographics
NPI:1174615975
Name:JENSEN, TIMOTHY JOHN (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:JENSEN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SW JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-1356
Mailing Address - Country:US
Mailing Address - Phone:641-743-2477
Mailing Address - Fax:
Practice Address - Street 1:101 SW JACKSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-1356
Practice Address - Country:US
Practice Address - Phone:641-743-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43684OtherWELLMARK-BCBS OF IA
IAI5865Medicare ID - Type UnspecifiedPERSONAL ID#