Provider Demographics
NPI:1174828644
Name:GEORGE L. JENKINS, D.C., P.C.
Entity Type:Organization
Organization Name:GEORGE L. JENKINS, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-273-5959
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-0116
Mailing Address - Country:US
Mailing Address - Phone:717-273-5959
Mailing Address - Fax:717-274-5450
Practice Address - Street 1:618 CORNWALL RD
Practice Address - Street 2:SUITE #1
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7089
Practice Address - Country:US
Practice Address - Phone:717-273-5959
Practice Address - Fax:717-274-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003199R261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30654Medicare UPIN