Provider Demographics
NPI:1477758209
Name:VINCENT, JENNA (DC)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:VINCENT
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 1:2211 CORINTH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1622
Mailing Address - Country:US
Mailing Address - Phone:310-445-3350
Mailing Address - Fax:310-445-3351
Practice Address - Street 1:2525 E THOMAS RD STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7935
Practice Address - Country:US
Practice Address - Phone:310-445-3350
Practice Address - Fax:310-445-3351
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8813111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation