Healthcare Provider Details

I. General information

NPI: 1609899186
Provider Name (Legal Business Name): JENNIFER LYNN MCCLEARY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S MERAMEC AVE SUITE 920T
CLAYTON MO
63105-3511
US

IV. Provider business mailing address

225 S MERAMEC AVE SUITE 920T
CLAYTON MO
63105-3511
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-4600
  • Fax: 314-833-4601
Mailing address:
  • Phone: 314-833-4600
  • Fax: 314-833-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2006000482
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: