Provider Demographics
NPI:1417333030
Name:DAVIS, JENNIFER ANNE (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-1950
Mailing Address - Country:US
Mailing Address - Phone:717-944-2225
Mailing Address - Fax:717-944-0932
Practice Address - Street 1:500 N UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057
Practice Address - Country:US
Practice Address - Phone:717-944-2225
Practice Address - Fax:717-944-0932
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ011002111N00000X
PADC011245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor