Provider Demographics
NPI:1215289459
Name:JENSEN HEALTH ENTERPRISES
Entity type:Organization
Organization Name:JENSEN HEALTH ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:636-386-3333
Mailing Address - Street 1:116B HOLLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3215
Mailing Address - Country:US
Mailing Address - Phone:636-386-3333
Mailing Address - Fax:636-527-2570
Practice Address - Street 1:116B HOLLOWAY RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3215
Practice Address - Country:US
Practice Address - Phone:636-386-3333
Practice Address - Fax:636-527-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133N00000X
MO20120005055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty