Provider Demographics
NPI:1639109382
Name:JONDELLE JENKINS
Entity Type:Organization
Organization Name:JONDELLE JENKINS
Other - Org Name:J B JENKINS & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONDELLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-374-5300
Mailing Address - Street 1:1706 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2740
Mailing Address - Country:US
Mailing Address - Phone:773-374-5300
Mailing Address - Fax:773-374-5860
Practice Address - Street 1:1706 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2740
Practice Address - Country:US
Practice Address - Phone:773-374-5300
Practice Address - Fax:773-374-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001621735OtherBCBS GROUP
ILDB8026OtherRAILROAD MEDICARE GROUP
ILDB8026OtherRAILROAD MEDICARE GROUP
IL0993630001Medicare NSC
ILDB8026OtherRAILROAD MEDICARE GROUP