Provider Demographics
NPI:1083830186
Name:JENKINS-COLLINS, SHARON E (DC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:JENKINS-COLLINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6522
Mailing Address - Country:US
Mailing Address - Phone:773-721-3000
Mailing Address - Fax:
Practice Address - Street 1:1401 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6522
Practice Address - Country:US
Practice Address - Phone:773-721-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N038007174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001605158OtherBCBS PROVIDER