Provider Demographics
NPI:1740472786
Name:JENKINS, DAVID JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
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 1:897 SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5360
Mailing Address - Country:US
Mailing Address - Phone:407-767-8209
Mailing Address - Fax:407-767-5488
Practice Address - Street 1:897 SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5360
Practice Address - Country:US
Practice Address - Phone:407-767-8209
Practice Address - Fax:407-767-5488
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89919YMedicare UPIN