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General NPI Number Information
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NPI Number | 1609304104
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Entity Type | Individual
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Provider Name | JEANETTA MARIE WILKERSON DC
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Gender | Female
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Dates
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Enumeration Date | 05/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 320 BROOKES DR STE 237
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City | HAZELWOOD
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State | MO
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Zip | 63042-2733
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Country | US
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Telephone | 314-225-8810
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Fax |
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Provider Business Mailing Address
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Address Line | 320 BROOKES DR STE 237
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City | HAZELWOOD
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State | MO
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Zip | 63042-2733
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Country | US
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Telephone | 314-225-8810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2016039732
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License Number State | MO
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