Provider Demographics
NPI:1093854283
Name:JENNINGS, EDWARD DEWEY (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DEWEY
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 1:4431 WOODSON AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3372
Mailing Address - Country:US
Mailing Address - Phone:916-729-2225
Mailing Address - Fax:916-925-8380
Practice Address - Street 1:2020 HURLEY WAY STE 485
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3273
Practice Address - Country:US
Practice Address - Phone:916-729-2225
Practice Address - Fax:916-925-8380
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27451111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0274510Medicare ID - Type Unspecified
CAT67038Medicare UPIN