MEDICARE: JENNA LYNNE SOLDANO DC

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	08003028A	IN

General Provider Information

NPI Number	:	1649769530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA LYNNE SOLDANO DC

Provider Business Mailing Address
First Line	:	10410 LILAC LN APT 1211
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2789
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1582
Country	:	US
Telephone Number	:	260-489-2266
Fax Number	:

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

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	05/07/2018

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