Provider Demographics
NPI:1427612688
Name:JENSEN, ERIN ROSE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ROSE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HILL ST E
Mailing Address - Street 2:
Mailing Address - City:NORWOOD YOUNG AMERICA
Mailing Address - State:MN
Mailing Address - Zip Code:55368-4565
Mailing Address - Country:US
Mailing Address - Phone:507-360-4369
Mailing Address - Fax:952-467-9104
Practice Address - Street 1:320 HILL ST E
Practice Address - Street 2:
Practice Address - City:NORWOOD YOUNG AMERICA
Practice Address - State:MN
Practice Address - Zip Code:55368
Practice Address - Country:US
Practice Address - Phone:952-467-2505
Practice Address - Fax:952-467-9104
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor