Provider Demographics
NPI:1093318040
Name:DEVENNEY, JENELLE (DC)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:DEVENNEY
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 1:79 HILLSDALE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1208
Mailing Address - Country:US
Mailing Address - Phone:517-439-9800
Mailing Address - Fax:
Practice Address - Street 1:79 HILLSDALE ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1208
Practice Address - Country:US
Practice Address - Phone:517-439-9800
Practice Address - Fax:517-439-1230
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301011024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301011024OtherSTATE LICENSE