Provider Demographics
NPI:1992120570
Name:JAHNA CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:JAHNA CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-949-4815
Mailing Address - Street 1:23857 HWY 27
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-7811
Mailing Address - Country:US
Mailing Address - Phone:863-949-4815
Mailing Address - Fax:863-949-4826
Practice Address - Street 1:23857 HWY 27
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-7811
Practice Address - Country:US
Practice Address - Phone:863-949-4815
Practice Address - Fax:863-949-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL220EPOtherBLUE CROSS BLUE SHIELD
FLHT002AMedicare UPIN