Provider Demographics
NPI:1851319123
Name:LENIHAN, JIM S
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:S
Last Name:LENIHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 RED HILL AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2469
Mailing Address - Country:US
Mailing Address - Phone:415-482-8282
Mailing Address - Fax:
Practice Address - Street 1:412 RED HILL AVE STE 11
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2469
Practice Address - Country:US
Practice Address - Phone:415-482-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor