Provider Demographics
NPI:1154360220
Name:JENSEN, SANDRA LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
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 1:13714 GAMMA RD
Mailing Address - Street 2:#125
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4485
Mailing Address - Country:US
Mailing Address - Phone:972-243-5757
Mailing Address - Fax:972-488-6988
Practice Address - Street 1:13714 GAMMA RD
Practice Address - Street 2:SUITE 125
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4485
Practice Address - Country:US
Practice Address - Phone:972-243-5757
Practice Address - Fax:972-488-6988
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601552Medicare PIN