Provider Demographics
NPI:1679692834
Name:JENKINS, CHERRON (DC)
Entity type:Individual
Prefix:DR
First Name:CHERRON
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:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:STATE PARK
Mailing Address - State:SC
Mailing Address - Zip Code:29147-0083
Mailing Address - Country:US
Mailing Address - Phone:803-626-7150
Mailing Address - Fax:
Practice Address - Street 1:4021 PERCIVAL RD APT 914
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8370
Practice Address - Country:US
Practice Address - Phone:803-626-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3222111N00000X
GACHIR008165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
511I350080Medicare PIN
SCAA6280E829Medicare PIN