Provider Demographics
NPI:1245212836
Name:CHEN, JACQUELINE BARBARA (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BARBARA
Last Name:CHEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2469
Mailing Address - Country:US
Mailing Address - Phone:573-855-9850
Mailing Address - Fax:847-504-5015
Practice Address - Street 1:425 HUELH RD, UNIT 13
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2319
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:847-504-5015
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01582259OtherRAILROAD MEDICARE
MOP01582259OtherRAILROAD MEDICARE
MO149630012Medicare PIN