Provider Demographics
NPI:1720122302
Name:JENNINGS, AMY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 LIBRARY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-4063
Mailing Address - Country:US
Mailing Address - Phone:412-283-1060
Mailing Address - Fax:412-283-1062
Practice Address - Street 1:6270 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-4063
Practice Address - Country:US
Practice Address - Phone:412-283-1060
Practice Address - Fax:412-283-1062
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008680680002Medicaid
PAJE1584238OtherHIGHMARK
PA1537844OtherGATEWAY
PA326349OtherUPMC
PA663887OtherACN
PAU99345Medicare UPIN
PA1008680680002Medicaid