Provider Demographics
NPI:1730239088
Name:JENKINS, ALETA LARK (DC)
Entity type:Individual
Prefix:DR
First Name:ALETA
Middle Name:LARK
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:P.O.BOX 92
Mailing Address - Street 2:1112 COMMERCIAL ST.
Mailing Address - City:GLEN COVE
Mailing Address - State:ME
Mailing Address - Zip Code:04846-0092
Mailing Address - Country:US
Mailing Address - Phone:207-596-5523
Mailing Address - Fax:207-596-5655
Practice Address - Street 1:1112 COMMERCIAL ST.
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:ME
Practice Address - Zip Code:04846-0092
Practice Address - Country:US
Practice Address - Phone:207-596-5523
Practice Address - Fax:207-596-5655
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEJEMM8100Medicare ID - Type Unspecified