Healthcare Provider Details

I. General information

NPI: 1437840600
Provider Name (Legal Business Name): JADE MONET DRYDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 SW 3RD ST
LEES SUMMIT MO
64063-2277
US

IV. Provider business mailing address

16183 S COLE ST
OLATHE KS
66062-3173
US

V. Phone/Fax

Practice location:
  • Phone: 816-287-4044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023015269
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: