Provider Demographics
NPI:1699326488
Name:SORENSEN, JUSTIN PAUL (CNIM, R EEG T)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PAUL
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:CNIM, R EEG T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SLATER
Mailing Address - State:IA
Mailing Address - Zip Code:50244-9705
Mailing Address - Country:US
Mailing Address - Phone:515-520-1608
Mailing Address - Fax:
Practice Address - Street 1:24 S WEBER ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1928
Practice Address - Country:US
Practice Address - Phone:866-226-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic