Provider Demographics
NPI:1972683530
Name:JENNINGS, MICHAEL B (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:JENNINGS
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 1:1907 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2425
Mailing Address - Country:US
Mailing Address - Phone:620-792-6854
Mailing Address - Fax:620-792-6841
Practice Address - Street 1:1907 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-2425
Practice Address - Country:US
Practice Address - Phone:620-792-6854
Practice Address - Fax:620-792-6841
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4566111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition