Provider Demographics
NPI:1447539796
Name:JENNINGS, SHAUN (DC)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 TOSCANA DR
Mailing Address - Street 2:123
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3628
Mailing Address - Country:US
Mailing Address - Phone:239-443-0870
Mailing Address - Fax:
Practice Address - Street 1:6151 TOSCANA DR
Practice Address - Street 2:123
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3628
Practice Address - Country:US
Practice Address - Phone:239-443-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor