Provider Demographics
NPI:1093041550
Name:LUTHER, JILL E (DC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:LUTHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1480 N GREEN MOUNT RD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3466
Mailing Address - Country:US
Mailing Address - Phone:618-622-2222
Mailing Address - Fax:618-624-8357
Practice Address - Street 1:2315 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8659
Practice Address - Country:US
Practice Address - Phone:636-978-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor