Provider Demographics
NPI:1053473975
Name:JENKINS, JAMES ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:JENKINS
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 1:477 E BUTTERFIELD RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5628
Mailing Address - Country:US
Mailing Address - Phone:630-796-2083
Mailing Address - Fax:630-442-7493
Practice Address - Street 1:477 E BUTTERFIELD RD STE 205
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5628
Practice Address - Country:US
Practice Address - Phone:630-796-2083
Practice Address - Fax:630-442-7493
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85073Medicare UPIN
L85781Medicare ID - Type Unspecified