Provider Demographics
NPI:1083039929
Name:THAKE, JULIANNE CHRISTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:CHRISTINE
Last Name:THAKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3146
Mailing Address - Country:US
Mailing Address - Phone:330-265-6113
Mailing Address - Fax:
Practice Address - Street 1:2705 SAINT PETERS HOWELL RD
Practice Address - Street 2:STE J
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2821
Practice Address - Country:US
Practice Address - Phone:636-248-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-01
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014038935111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor