Provider Demographics
NPI:1124129101
Name:JENSEN, SUSAN A (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 N EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1127
Mailing Address - Country:US
Mailing Address - Phone:316-670-9004
Mailing Address - Fax:
Practice Address - Street 1:8404 W 13TH ST N STE 150
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212
Practice Address - Country:US
Practice Address - Phone:316-796-5421
Practice Address - Fax:316-796-5419
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU80915Medicare UPIN
KS060396Medicare ID - Type Unspecified