Provider Demographics
NPI:1811092943
Name:JENNINGS, TIMOTHY JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:JENNINGS
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 1:1190 S BASCOM AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3545
Mailing Address - Country:US
Mailing Address - Phone:408-293-2225
Mailing Address - Fax:
Practice Address - Street 1:1190 S. BASCOM AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1656
Practice Address - Country:US
Practice Address - Phone:408-293-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0213790OtherBLUE SHIELD
CADC0213790Medicare ID - Type Unspecified