Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1371 | CT |
NPI | 1619034733 |
---|---|
Provider Name | Dr. Jason R Jenkins |
First Address | Milford, CT 06460-4812 |
Second Address | Milford, CT 06460-4812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050001371CT02 | ANTHEM PROVIDER NUMBER (01) | CT |
1998049 | UNITED HEALTH PROVIDER NO (01) | CT |
3191251 | AETNA PROVIDER NUMBER (01) | CT |
P2188667 | OXFORD PROVIDER NUMBER (01) | CT |
U82466 | (02) | CT |