Provider Demographics
NPI:1295930238
Name:DEGARAY, JENNIFER ROBIN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROBIN
Last Name:DEGARAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ROBIN
Other - Last Name:TKACHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6580 OLD MONROE RD STE A
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5362
Mailing Address - Country:US
Mailing Address - Phone:704-225-8686
Mailing Address - Fax:704-225-9988
Practice Address - Street 1:6580 OLD MONROE RD STE A
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5362
Practice Address - Country:US
Practice Address - Phone:704-225-8686
Practice Address - Fax:704-225-9988
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010911111N00000X
NC3794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor