Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC11749 | CA |
N | 111NI0013X | Independent Medical Examiner | DC11749 | CA |
NPI | 1275745218 |
---|---|
Provider Name | Dr. Gregory R. Jenison |
First Address | Orangevale, CA 95662-4538 |
Second Address | Orangevale, CA 95662-4538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |