Provider Demographics
NPI:1740020460
Name:FAIRCHILD, JENNA JAY (DC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:JAY
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:JAY
Other - Last Name:FAIRCHILD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:307 RUSH ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6742
Mailing Address - Country:US
Mailing Address - Phone:386-589-5820
Mailing Address - Fax:
Practice Address - Street 1:307 RUSH ST UNIT 5
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6742
Practice Address - Country:US
Practice Address - Phone:386-589-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor