Provider Demographics
NPI:1659439545
Name:JENKINS, GENE EDGAR JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:EDGAR
Last Name:JENKINS
Suffix:JR
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 1:1298 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1765
Mailing Address - Country:US
Mailing Address - Phone:850-668-4057
Mailing Address - Fax:
Practice Address - Street 1:1298 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1765
Practice Address - Country:US
Practice Address - Phone:850-668-4057
Practice Address - Fax:850-668-3594
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22694OtherBCBS PROVIDER
FLU25750Medicare UPIN