Provider Demographics
NPI:1215648381
Name:JENSEN WELLNESS
Entity type:Organization
Organization Name:JENSEN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARIAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-207-9272
Mailing Address - Street 1:PO BOX 8111
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-2111
Mailing Address - Country:US
Mailing Address - Phone:208-207-9272
Mailing Address - Fax:208-980-7953
Practice Address - Street 1:711 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1445
Practice Address - Country:US
Practice Address - Phone:208-605-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No283X00000XHospitalsRehabilitation HospitalGroup - Single Specialty