MEDICARE: JENNIFER LEARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2025053733	MO

General Provider Information

NPI Number	:	1225994221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEARY

Provider Business Mailing Address
First Line	:	12636 LAMPLIGHTER SQUARE SHPG CTR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12636 LAMPLIGHTER SQUARE SHPG CTR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2746
Country	:	US
Telephone Number	:	856-430-4531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	05/21/2026

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Directions to “ JENNIFER LEARY ” Practice Location

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