Provider Demographics
NPI:1164840237
Name:JENNINGS, RAYMOND ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ROBERT
Last Name:JENNINGS
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 1:4911 CATALINA SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9675
Mailing Address - Country:US
Mailing Address - Phone:317-697-7484
Mailing Address - Fax:
Practice Address - Street 1:4911 CATALINA SOUTH DR
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9675
Practice Address - Country:US
Practice Address - Phone:317-697-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002762A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor