Provider Demographics
NPI:1972655835
Name:JENKINS, BRIAN JEFFERSON (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JEFFERSON
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:JEFFERSON
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:37 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3317
Mailing Address - Country:US
Mailing Address - Phone:740-775-0550
Mailing Address - Fax:740-775-0552
Practice Address - Street 1:37 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3317
Practice Address - Country:US
Practice Address - Phone:740-775-0550
Practice Address - Fax:740-775-0552
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0811518Medicaid
OH000000120416OtherANTHEM PIN NUMBER
OH4400286OtherUNITED HEALTHCARE PROVIDE
OHT32450Medicare UPIN
OH000000120416OtherANTHEM PIN NUMBER