Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 001136 | CT |
Y | 111NN1001X | Nutrition | 001136 | CT |
NPI | 1033214135 |
---|---|
Provider Name | Dr. Avery L Jenkins |
First Address | Litchfield, CT 06759-2725 |
Second Address | Litchfield, CT 06759-2725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 03/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U57798 | (02) | CT |
V4534 | (02) | CT |