Provider Demographics
NPI:1831278357
Name:PATRICIA M JENKINS DC A PROFESSIONAL CHIROPRACTIC CORP
Entity type:Organization
Organization Name:PATRICIA M JENKINS DC A PROFESSIONAL CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-982-7249
Mailing Address - Street 1:300 EAST 7TH STREET
Mailing Address - Street 2:STE 2F
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6778
Mailing Address - Country:US
Mailing Address - Phone:909-982-7249
Mailing Address - Fax:909-982-7250
Practice Address - Street 1:300 EAST 7TH STREET
Practice Address - Street 2:STE 2F
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6778
Practice Address - Country:US
Practice Address - Phone:909-982-7249
Practice Address - Fax:909-982-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T04134Medicare UPIN
DC0109450Medicare ID - Type Unspecified