Provider Demographics
NPI:1154357093
Name:EISENBERG, JENNA (DC)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N730 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2944
Mailing Address - Country:US
Mailing Address - Phone:630-653-4195
Mailing Address - Fax:630-653-4196
Practice Address - Street 1:0N730 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2944
Practice Address - Country:US
Practice Address - Phone:630-653-4195
Practice Address - Fax:630-653-4196
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38004707111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
697780Medicare UPIN