Provider Demographics
NPI:1497980395
Name:PROENZA, JENNY (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:PROENZA
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 1:284 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2407
Mailing Address - Country:US
Mailing Address - Phone:415-648-6481
Mailing Address - Fax:415-648-6498
Practice Address - Street 1:284 29TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2407
Practice Address - Country:US
Practice Address - Phone:415-648-6481
Practice Address - Fax:415-648-6498
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor