MEDICARE: GENE E JENKINS JR,DC,PA

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 5794	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22694	OTHER	FL	BCBS FLORIDA

General Provider Information

NPI Number	:	1902112824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENE E JENKINS JR,DC,PA

Provider Business Mailing Address
First Line	:	1298 TIMBERLANE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1765
Country	:	US
Telephone Number	:	850-668-4057
Fax Number	:	850-668-3594

Provider Business Practice Location Address
First Line	:	1298 TIMBERLANE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1765
Country	:	US
Telephone Number	:	850-668-4057
Fax Number	:	850-668-3594

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GENE EDGAR JENKINS JR.
Credential	:	DC
Telephone Number	:	850-668-4057

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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