Provider Demographics
NPI:1346571148
Name:DR. JEN ROCKS, LLC
Entity Type:Organization
Organization Name:DR. JEN ROCKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-264-2244
Mailing Address - Street 1:208 SCRANTON CONNECTOR STE 120
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0561
Mailing Address - Country:US
Mailing Address - Phone:912-264-2244
Mailing Address - Fax:404-855-4381
Practice Address - Street 1:208 SCRANTON CONNECTOR STE 120
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0561
Practice Address - Country:US
Practice Address - Phone:912-264-2244
Practice Address - Fax:404-855-4381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009039698111N00000X
GACHIR009588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962732669OtherNPI
EA2937OtherRRB
P02546258OtherRRB