Provider Demographics
NPI:1205429024
Name:SCANLON, JENNIFER RAE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RAE
Last Name:SCANLON
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 1:1632 SAVANNAH RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1659
Mailing Address - Country:US
Mailing Address - Phone:303-313-5467
Mailing Address - Fax:
Practice Address - Street 1:530 COLLEGE PKWY
Practice Address - Street 2:STE F
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409
Practice Address - Country:US
Practice Address - Phone:410-349-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0011039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor