Provider Demographics
NPI:1710519053
Name:JENKINS, DYLAN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:RAY
Last Name:JENKINS
Suffix:
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 1:207 N CHESTNUT ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2932
Mailing Address - Country:US
Mailing Address - Phone:952-288-7577
Mailing Address - Fax:
Practice Address - Street 1:207 N CHESTNUT ST STE 130
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2932
Practice Address - Country:US
Practice Address - Phone:952-288-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6707111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty