Provider Demographics
NPI:1669567624
Name:JENKINS, KENNETH A (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:JENKINS
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 1:3600 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8407
Mailing Address - Country:US
Mailing Address - Phone:727-327-4522
Mailing Address - Fax:727-327-8069
Practice Address - Street 1:3600 1ST AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8407
Practice Address - Country:US
Practice Address - Phone:727-327-4522
Practice Address - Fax:727-327-8069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH317111NX0800X
KY4692111NX0800X
PADC008775111NX0800X
OH2114111NX0800X
FLCH11270111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0991397Medicaid
OH0991397Medicaid
OHU51245Medicare UPIN