Provider Demographics
NPI:1740237890
Name:JENNINGS, MARY MARGARET (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 KEISLER DR STE 203
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9321
Mailing Address - Country:US
Mailing Address - Phone:984-233-5992
Mailing Address - Fax:984-233-5995
Practice Address - Street 1:543 KEISLER DR STE 203
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9321
Practice Address - Country:US
Practice Address - Phone:984-233-5992
Practice Address - Fax:984-233-5995
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC767171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U75664Medicare UPIN
U75664Medicare UPIN
590470Medicare ID - Type Unspecified