Provider Demographics
NPI:1386630978
Name:JENSON, DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:JENSON
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 1:2211 US HIGHWAY 169 N
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-7219
Mailing Address - Country:US
Mailing Address - Phone:515-295-7744
Mailing Address - Fax:515-295-7370
Practice Address - Street 1:2211 US HIGHWAY 169 N
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-7219
Practice Address - Country:US
Practice Address - Phone:515-295-7744
Practice Address - Fax:515-295-7370
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-10-10
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
IA5046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23087OtherBLUE CROSS
IDIA01568OtherEDI SUBMITTER
IA0230870Medicaid
IA0230870Medicaid