Provider Demographics
NPI:1669528261
Name:JENNINGS, STEPHEN LAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LAYNE
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 1:101 N AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2657
Mailing Address - Country:US
Mailing Address - Phone:219-866-7164
Mailing Address - Fax:219-866-0515
Practice Address - Street 1:101 N AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2657
Practice Address - Country:US
Practice Address - Phone:219-866-7164
Practice Address - Fax:219-866-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000578A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor