Healthcare Provider Details

I. General information

NPI: 1174828644
Provider Name (Legal Business Name): GEORGE L. JENKINS, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 CORNWALL RD SUITE #1
LEBANON PA
17042-7089
US

IV. Provider business mailing address

PO BOX 116
LEBANON PA
17042-0116
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-5959
  • Fax: 717-274-5450
Mailing address:
  • Phone: 717-273-5959
  • Fax: 717-274-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberDC003199R
License Number StatePA

VIII. Authorized Official

Name: DR. GEORGE L JENKINS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 717-273-5959