Provider Demographics
NPI:1659644094
Name:PARADIGM CHIROPRACTIC AND PERFORMANCE LLC
Entity Type:Organization
Organization Name:PARADIGM CHIROPRACTIC AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:202-546-0981
Mailing Address - Street 1:650 PENNSYLVANIA AVE SE
Mailing Address - Street 2:STE. 470
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4318
Mailing Address - Country:US
Mailing Address - Phone:202-546-0981
Mailing Address - Fax:202-747-7716
Practice Address - Street 1:650 PENNSYLVANIA AVE SE
Practice Address - Street 2:STE. 470
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4318
Practice Address - Country:US
Practice Address - Phone:202-546-0981
Practice Address - Fax:202-747-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030095305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC240617Medicare UPIN