Provider Demographics
NPI:1336490366
Name:JENNINGS, TYLER JEFFORY (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JEFFORY
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 1:625 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3127
Mailing Address - Country:US
Mailing Address - Phone:931-542-9420
Mailing Address - Fax:931-542-9422
Practice Address - Street 1:625 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3127
Practice Address - Country:US
Practice Address - Phone:931-542-9420
Practice Address - Fax:931-542-9422
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2780111N00000X
IL038012266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038012266OtherLICENSE #
TN2780OtherTENNESSEE LICENSE