Provider Demographics
NPI:1205115334
Name:JENKINS, CHRISTOPHER JEROME (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JEROME
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2732
Mailing Address - Country:US
Mailing Address - Phone:850-381-2610
Mailing Address - Fax:
Practice Address - Street 1:424 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2732
Practice Address - Country:US
Practice Address - Phone:850-381-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63539172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker