Healthcare Provider Details

I. General information

NPI: 1477595221
Provider Name (Legal Business Name): JENNIFER CHRISTINE KANE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OZARK TRAIL DR STE 105
ELLISVILLE MO
63011-2156
US

IV. Provider business mailing address

1292 STILL HOUSE CREEK RD
CHESTERFIELD MO
63017-1956
US

V. Phone/Fax

Practice location:
  • Phone: 636-207-6600
  • Fax: 636-207-6631
Mailing address:
  • Phone: 314-496-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2001011188
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: