Provider Demographics
NPI:1124290929
Name:JENNINGS, MATTHEW DALE (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DALE
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 1:1408 LEXINGTON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2630
Mailing Address - Country:US
Mailing Address - Phone:419-756-6262
Mailing Address - Fax:419-774-0592
Practice Address - Street 1:1408 LEXINGTON AVE STE C
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2630
Practice Address - Country:US
Practice Address - Phone:419-756-6262
Practice Address - Fax:419-774-0592
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor