Provider Demographics
NPI:1164941852
Name:VANDERKLEI, JESSICA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:VANDERKLEI
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 1:705 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-8102
Mailing Address - Country:US
Mailing Address - Phone:816-625-1598
Mailing Address - Fax:816-625-1599
Practice Address - Street 1:705 S BROADWAY
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-8102
Practice Address - Country:US
Practice Address - Phone:816-625-1598
Practice Address - Fax:816-625-1599
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017033050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor