Provider Demographics
NPI:1730365933
Name:JENSEN CHIROPRACTIC INC
Entity type:Organization
Organization Name:JENSEN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-323-1222
Mailing Address - Street 1:495 APPLE ST
Mailing Address - Street 2:STE 105
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3553
Mailing Address - Country:US
Mailing Address - Phone:775-323-1222
Mailing Address - Fax:775-323-7002
Practice Address - Street 1:495 APPLE ST
Practice Address - Street 2:STE 105
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3553
Practice Address - Country:US
Practice Address - Phone:775-323-1222
Practice Address - Fax:775-323-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105095Medicare UPIN