Provider Demographics
NPI:1750920237
Name:JENNINGS FAMILY CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:JENNINGS FAMILY CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-282-7414
Mailing Address - Street 1:113 FLAGG PLACE SUITE A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7025
Mailing Address - Country:US
Mailing Address - Phone:337-983-2273
Mailing Address - Fax:
Practice Address - Street 1:113 FLAGG PLACE SUITE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7025
Practice Address - Country:US
Practice Address - Phone:337-983-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty