Provider Demographics
NPI:1326197252
Name:OLENJACK CHIROPRACTIC
Entity Type:Organization
Organization Name:OLENJACK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLENJACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-729-0027
Mailing Address - Street 1:4600 S LINDBERGH BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1830
Mailing Address - Country:US
Mailing Address - Phone:317-729-0027
Mailing Address - Fax:
Practice Address - Street 1:4600 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1830
Practice Address - Country:US
Practice Address - Phone:317-729-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID