Provider Demographics
NPI:1447250444
Name:JENKINS, MARTHA (DC)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4696 OVERLAND ROAD
Mailing Address - Street 2:SUITE 182
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-323-8315
Mailing Address - Fax:208-345-5260
Practice Address - Street 1:4696 OVERLAND RD
Practice Address - Street 2:SUITE 182
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2845
Practice Address - Country:US
Practice Address - Phone:208-323-8315
Practice Address - Fax:208-345-5260
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-629111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC3704OtherBLUE CROSS PIN
ID000010019263OtherBLUE SHIELD PIN
ID1673037Medicare ID - Type UnspecifiedPROVIDER NUMBER
IDT17866Medicare UPIN