Healthcare Provider Details

I. General information

NPI: 1851449250
Provider Name (Legal Business Name): TRIAD SPORTS AND FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 BONHOMME AVE STE 100
SAINT LOUIS MO
63105-3538
US

IV. Provider business mailing address

8025 BONHOMME AVE STE 100
CLAYTON MO
63105-3538
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-4600
  • Fax: 888-451-0957
Mailing address:
  • Phone: 314-833-4600
  • Fax: 888-451-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER LYNN MCCLEARY
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 314-833-4600