Provider Demographics
NPI:1689824344
Name:JENISON, ANDREW WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WILLIAM
Last Name:JENISON
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 1:4600 KIETZKE LN STE M249
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5000
Mailing Address - Country:US
Mailing Address - Phone:775-825-3625
Mailing Address - Fax:775-825-3628
Practice Address - Street 1:4600 KIETZKE LN STE M249
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5000
Practice Address - Country:US
Practice Address - Phone:775-825-3625
Practice Address - Fax:775-825-3628
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVBO1357111N00000X
CA11944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor