Provider Demographics
NPI:1639314479
Name:JENKINS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:JENKINS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-877-4198
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1998049OtherUNITED HEALTH CARE PROVIDER NUMBER
CT3191251OtherAETNA PROVIDER NUMBER
CT050001371CT02OtherANTHEM BC/BS PROVIDER NUMBER
CTU82466OtherUNIVERSAL PIN NUMBER