Provider Demographics
NPI:1619034733
Name:JENKINS, JASON R (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
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 1:97 GULF ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4812
Mailing Address - Country:US
Mailing Address - Phone:203-877-4198
Mailing Address - Fax:203-877-6394
Practice Address - Street 1:97 GULF ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4812
Practice Address - Country:US
Practice Address - Phone:203-877-4198
Practice Address - Fax:203-877-6394
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1371111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3191251OtherAETNA PROVIDER NUMBER
CT1998049OtherUNITED HEALTH PROVIDER NO
CT050001371CT02OtherANTHEM PROVIDER NUMBER
CTP2188667OtherOXFORD PROVIDER NUMBER
CTU82466Medicare UPIN