Provider Demographics
NPI:1417492075
Name:LANGENDERFER, JENNA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:LYNN
Last Name:LANGENDERFER
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 1:1 FLORIDA PARK DR N STE 106
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3843
Mailing Address - Country:US
Mailing Address - Phone:386-603-8001
Mailing Address - Fax:386-603-4111
Practice Address - Street 1:1 FLORIDA PARK DR N
Practice Address - Street 2:STE 106
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3843
Practice Address - Country:US
Practice Address - Phone:386-603-8001
Practice Address - Fax:386-603-4111
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor