Individual
MARK JENNINGS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
PEDIATRIC NEUROLOGY, 515 NE GLEN OAK #308, PEORIA, IL 61603
(309) 624-9844
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-8503
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07215036
BCBS
IL
01
—
IL01DP
JOHN DEERE
IL
Enumeration date
02/15/2006
Last updated
07/09/2007
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