Provider Demographics
NPI:1699835132
Name:JENNINGS CHIROPRACTIC, INC., P.S.
Entity type:Organization
Organization Name:JENNINGS CHIROPRACTIC, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-299-8999
Mailing Address - Street 1:3218 R AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-3449
Mailing Address - Country:US
Mailing Address - Phone:360-299-8999
Mailing Address - Fax:360-299-8135
Practice Address - Street 1:3218 R AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3449
Practice Address - Country:US
Practice Address - Phone:360-299-8999
Practice Address - Fax:360-299-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA05625OtherREGENCE BS
WA2013092Medicaid
WA25762OtherL & I
WA05625OtherREGENCE BS
WA25762OtherL & I