Provider Demographics
NPI:1679619175
Name:DR STEPHEN L JENNINGS PC
Entity Type:Organization
Organization Name:DR STEPHEN L JENNINGS PC
Other - Org Name:JENNINGS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-866-7164
Mailing Address - Street 1:101 N AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2657
Mailing Address - Country:US
Mailing Address - Phone:219-866-7164
Mailing Address - Fax:219-866-0515
Practice Address - Street 1:101 N AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2657
Practice Address - Country:US
Practice Address - Phone:219-866-7164
Practice Address - Fax:219-866-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000578A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty