Provider Demographics
NPI:1558423467
Name:JENKINS, MOIRA C (DC)
Entity Type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:C
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MOIRA
Other - Middle Name:JEAN
Other - Last Name:CONROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:477 E BUTTERFIELD RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5628
Mailing Address - Country:US
Mailing Address - Phone:630-796-2083
Mailing Address - Fax:630-442-7493
Practice Address - Street 1:477 E BUTTERFIELD RD STE 205
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-796-2083
Practice Address - Fax:630-442-7493
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006283111N00000X
IL038006283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
L85782Medicare ID - Type Unspecified
U12568Medicare UPIN