Healthcare Provider Details

I. General information

NPI: 1669567624
Provider Name (Legal Business Name): KENNETH A JENKINS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 1ST AVE N
SAINT PETERSBURG FL
33713-8407
US

IV. Provider business mailing address

3600 1ST AVE N
SAINT PETERSBURG FL
33713-8407
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-4522
  • Fax: 727-327-8069
Mailing address:
  • Phone: 727-327-4522
  • Fax: 727-327-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number317
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number4692
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC008775
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2114
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH11270
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: