Provider Demographics
NPI:1336248756
Name:JENNINGS, JOHN T (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
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 1:711 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666
Mailing Address - Country:US
Mailing Address - Phone:410-643-7100
Mailing Address - Fax:410-643-9493
Practice Address - Street 1:711 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666
Practice Address - Country:US
Practice Address - Phone:410-643-7100
Practice Address - Fax:410-643-9493
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0586388OtherAETNA
MD350035280OtherRAIL ROAD MEDICARE
MD42514402OtherCAREFIRST OF MD
MDT447-0001OtherBLUE CROSS OF DC
MD200321OtherUNITED HEALTH CARE
MD219508OtherALLIANCE
MD200321OtherACN GROUP
MDM380OtherBLUE CROSS OF MARYLAND
MD219508OtherMAMSI
MD219508OtherALLIANCE
MDM380OtherBLUE CROSS OF MARYLAND