Provider Demographics
NPI:1902995590
Name:JORGENSEN, BRUCE H (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:JORGENSEN
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 1:2801 MERIDIAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2400
Mailing Address - Country:US
Mailing Address - Phone:360-738-9588
Mailing Address - Fax:360-715-1970
Practice Address - Street 1:2801 MERIDIAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2400
Practice Address - Country:US
Practice Address - Phone:360-738-9588
Practice Address - Fax:360-715-1970
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0002452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010445Medicaid
WA2010445Medicaid