Healthcare Provider Details

I. General information

NPI: 1467364133
Provider Name (Legal Business Name): STEVEN GEORGE JENKINS JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13575 S AIRPORT RD STE 105
LANSING MI
48906-9187
US

IV. Provider business mailing address

3652 WINBORN DR
DEWITT MI
48820-7898
US

V. Phone/Fax

Practice location:
  • Phone: 517-668-0000
  • Fax:
Mailing address:
  • Phone: 517-230-7638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601000865
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: