Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2114 | OH |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 317 | OH |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 4692 | KY |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH11270 | FL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC008775 | PA |
NPI | 1669567624 |
---|---|
Provider Name | Dr. Kenneth A Jenkins |
First Address | Saint Petersburg, FL 33713-8407 |
Second Address | Saint Petersburg, FL 33713-8407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 09/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0991397 | (05) | OH |
U51245 | (02) | OH |