Healthcare Provider Details

I. General information

NPI: 1013945153
Provider Name (Legal Business Name): JENNIFER LOGAN LAIRD D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WASHINGTON ST.
FREEPORT FL
32439-0625
US

IV. Provider business mailing address

40 WASHINGTON ST
FREEPORT FL
32439-0625
US

V. Phone/Fax

Practice location:
  • Phone: 850-835-9867
  • Fax: 850-880-6089
Mailing address:
  • Phone: 850-835-9867
  • Fax: 850-880-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: