Provider Demographics
NPI:1962871095
Name:JENKINSON, CARSON (DC)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:JENKINSON
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 1:3441 LEBANON PIKE
Mailing Address - Street 2:STE 117
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2000
Mailing Address - Country:US
Mailing Address - Phone:615-871-9000
Mailing Address - Fax:615-871-9018
Practice Address - Street 1:230 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:IN
Practice Address - Zip Code:47390-1432
Practice Address - Country:US
Practice Address - Phone:765-748-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5473111N00000X
IN08002865A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor