Provider Demographics
NPI:1902318017
Name:LANGSTON, JENNA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:MOSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40011-0293
Mailing Address - Country:US
Mailing Address - Phone:502-532-0099
Mailing Address - Fax:502-532-0096
Practice Address - Street 1:8172 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSBURG
Practice Address - State:KY
Practice Address - Zip Code:40011-1467
Practice Address - Country:US
Practice Address - Phone:502-532-0099
Practice Address - Fax:502-532-0096
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04770111N00000X
KY5594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty