Provider Demographics
NPI:1003238015
Name:WAKULA, JENEANE
Entity Type:Individual
Prefix:
First Name:JENEANE
Middle Name:
Last Name:WAKULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9080 SE JUPITER NARROWS PL
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-3265
Mailing Address - Country:US
Mailing Address - Phone:772-546-9591
Mailing Address - Fax:
Practice Address - Street 1:8929 SE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-5312
Practice Address - Country:US
Practice Address - Phone:772-546-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor