Provider Demographics
NPI:1992919922
Name:JENSEN, WILLIAM J (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:JENSEN
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 1:10198 SW VILLAGE PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2592
Mailing Address - Country:US
Mailing Address - Phone:772-879-8700
Mailing Address - Fax:772-879-8710
Practice Address - Street 1:10198 SW VILLAGE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2592
Practice Address - Country:US
Practice Address - Phone:772-879-8700
Practice Address - Fax:772-879-8710
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor