Provider Demographics
NPI:1750402749
Name:JENNINGS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:JENNINGS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:LENDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-824-8200
Mailing Address - Street 1:15375 HIGHWAY 26
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3101
Mailing Address - Country:US
Mailing Address - Phone:337-824-8200
Mailing Address - Fax:337-824-8277
Practice Address - Street 1:15375 HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3101
Practice Address - Country:US
Practice Address - Phone:337-824-8200
Practice Address - Fax:337-824-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1531766Medicaid
LA1531766Medicaid
LA5CM18Medicare PIN