Provider Demographics
NPI:1922032572
Name:LOGSDON, JENNIFER ANN (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:LOGSDON
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 1:1807 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-5632
Mailing Address - Country:US
Mailing Address - Phone:405-224-0884
Mailing Address - Fax:405-224-0887
Practice Address - Street 1:1807 S 9TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-5632
Practice Address - Country:US
Practice Address - Phone:405-224-0884
Practice Address - Fax:405-224-0887
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor