Provider Demographics
NPI:1215083241
Name:JENSEN, DAVID S (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MIDLAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8305
Mailing Address - Country:US
Mailing Address - Phone:970-279-4099
Mailing Address - Fax:970-797-4812
Practice Address - Street 1:110 MIDLAND AVE
Practice Address - Street 2:STE 2
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8305
Practice Address - Country:US
Practice Address - Phone:970-279-4099
Practice Address - Fax:970-797-4812
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4085111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC428318Medicare ID - Type Unspecified
COU78043Medicare UPIN