Healthcare Provider Details

I. General information

NPI: 1902601545
Provider Name (Legal Business Name): JORDAN SNEED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10279 CLAYTON RD
SAINT LOUIS MO
63124-1115
US

IV. Provider business mailing address

319 RACE HORSE LN
WENTZVILLE MO
63385-3876
US

V. Phone/Fax

Practice location:
  • Phone: 314-390-9915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2025002628
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: