Provider Demographics
NPI:1568025831
Name:JENNINGS, ROBERT OAK
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:OAK
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 ALAFAYA TRL STE 1061
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4740
Mailing Address - Country:US
Mailing Address - Phone:407-542-7785
Mailing Address - Fax:
Practice Address - Street 1:1121 ALAFAYA TRL STE 1061
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4740
Practice Address - Country:US
Practice Address - Phone:407-542-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor