Provider Demographics
NPI:1962583088
Name:OLTJENBRUNS, JURGEN (DC)
Entity type:Individual
Prefix:DR
First Name:JURGEN
Middle Name:
Last Name:OLTJENBRUNS
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:P.O. BOX 232
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85327-0232
Mailing Address - Country:US
Mailing Address - Phone:480-488-1282
Mailing Address - Fax:480-480-9040
Practice Address - Street 1:7208 E CAVE CREEK RD
Practice Address - Street 2:SUITE F
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:480-488-1282
Practice Address - Fax:480-488-9040
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0246850OtherBCBS OF AZ
AZZ71529Medicare PIN
AZU52245Medicare UPIN