Provider Demographics
NPI:1053594028
Name:JENSEN, LISA (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:DIIORIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:23531 N EAST DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-894-4889
Mailing Address - Fax:
Practice Address - Street 1:23531 N EAST DR
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-894-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor