Healthcare Provider Details

I. General information

NPI: 1033214135
Provider Name (Legal Business Name): AVERY L JENKINS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 TORRINGTON RD
LITCHFIELD CT
06759-2725
US

IV. Provider business mailing address

286 TORRINGTON RD
LITCHFIELD CT
06759-2725
US

V. Phone/Fax

Practice location:
  • Phone: 860-567-5727
  • Fax: 860-567-2667
Mailing address:
  • Phone: 860-567-5727
  • Fax: 860-567-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number001136
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001136
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: