Provider Demographics
NPI:1154417327
Name:BRIAN D JENKINS CHIROPRACTIC INC
Entity type:Organization
Organization Name:BRIAN D JENKINS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-962-0144
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-0126
Mailing Address - Country:US
Mailing Address - Phone:916-962-0144
Mailing Address - Fax:916-965-4129
Practice Address - Street 1:4136 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7413
Practice Address - Country:US
Practice Address - Phone:916-962-0144
Practice Address - Fax:916-965-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0259740Medicare UPIN
CAZZZ05674ZMedicare PIN