Provider Demographics
NPI:1427363779
Name:JENKINS, LOGAN JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:JACK
Last Name:JENKINS
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 1:1520 MIDLAND CT NE STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-8404
Mailing Address - Country:US
Mailing Address - Phone:319-531-8800
Mailing Address - Fax:
Practice Address - Street 1:1520 MIDLAND CT NE STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-8404
Practice Address - Country:US
Practice Address - Phone:319-531-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010013426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor