Healthcare Provider Details

I. General information

NPI: 1750245080
Provider Name (Legal Business Name): RAPHA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12636 LAMPLIGHTER SQUARE SHPG CTR
SAINT LOUIS MO
63128-2746
US

IV. Provider business mailing address

12906 AUTUMN VIEW DR
SAINT LOUIS MO
63146-4331
US

V. Phone/Fax

Practice location:
  • Phone: 856-430-4531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LEARY
Title or Position: OWNER
Credential: DC
Phone: 856-430-4531