Provider Demographics
NPI:1588713994
Name:JENKINS CHIROPRACTIC LTD
Entity type:Organization
Organization Name:JENKINS CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT JENKINS CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-464-5797
Mailing Address - Street 1:477 E BUTTERFIELD RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5628
Mailing Address - Country:US
Mailing Address - Phone:630-796-2083
Mailing Address - Fax:630-442-7493
Practice Address - Street 1:477 E BUTTERFIELD RD STE 205
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-796-2083
Practice Address - Fax:630-442-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2215631OtherBLUE CROSS BLUE SHIELD
2215631OtherBLUE CROSS BLUE SHIELD