Provider Demographics
NPI:1679828370
Name:CHATHAM, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CHATHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6587
Mailing Address - Country:US
Mailing Address - Phone:217-698-1111
Mailing Address - Fax:217-698-1110
Practice Address - Street 1:3315 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6587
Practice Address - Country:US
Practice Address - Phone:217-698-1111
Practice Address - Fax:217-698-1110
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012189111N00000X
MO2012013173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor