Provider Demographics
NPI:1790401693
Name:MOONEY, JENNA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:MOONEY
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 1:7391 BRANDT PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3274
Mailing Address - Country:US
Mailing Address - Phone:937-236-1705
Mailing Address - Fax:937-236-1735
Practice Address - Street 1:7391 BRANDT PIKE STE C
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3274
Practice Address - Country:US
Practice Address - Phone:937-236-1705
Practice Address - Fax:937-236-1735
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDC-05188OtherCHIROPRACTIC LICENSE NUMBER