Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHR 5825 | CO |
NPI | 1255394755 |
---|---|
Provider Name | Dr. Robert C Jensen |
First Address | Englewood, CO 80111-5331 |
Second Address | Englewood, CO 80111-5331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 30/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000925 | QUALIFIED MED EXAMINER (01) | |
CHR 5825 | MEDICARE ID-TYPE UNSPECIFIED (01) | CO |
U30428 | (02) |