Healthcare Provider Details

I. General information

NPI: 1760745772
Provider Name (Legal Business Name): JENNIFER RAE BRILL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 SW LEMANS LN
LEES SUMMIT MO
64082-4619
US

IV. Provider business mailing address

931 SW LEMANS LN
LEES SUMMIT MO
64082-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-623-3020
  • Fax: 816-623-3076
Mailing address:
  • Phone: 816-623-3020
  • Fax: 816-623-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2012015058
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: