MEDICARE: DR. MARC FREDERICK JENKINS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	38MC00622500	NJ

General Provider Information

NPI Number	:	1710039490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC FREDERICK JENKINS D.C.

Provider Business Mailing Address
First Line	:	506 MAIN ST
Second Line	:
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720-1010
Country	:	US
Telephone Number	:	732-775-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 MAIN ST
Second Line	:
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720-1010
Country	:	US
Telephone Number	:	732-775-4448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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