MEDICARE: DR. JENNA LYNN LANGENDERFER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH 11994	FL

General Provider Information

NPI Number	:	1417492075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA LYNN LANGENDERFER D.C.

Provider Business Mailing Address
First Line	:	1 FLORIDA PARK DR N STE 106
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-3843
Country	:	US
Telephone Number	:	386-603-8001
Fax Number	:	386-603-4111

Provider Business Practice Location Address
First Line	:	1 FLORIDA PARK DR N
Second Line	:	STE 106
City	:	PALM COAST
State	:	FL
Zip	:	32137-3843
Country	:	US
Telephone Number	:	386-603-8001
Fax Number	:	386-603-4111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2017
Last Update Date	:	11/21/2019

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