Provider Demographics
NPI:1346212875
Name:CLEAR, JENNI (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNI
Middle Name:
Last Name:CLEAR
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 1:603 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371
Mailing Address - Country:US
Mailing Address - Phone:260-726-3404
Mailing Address - Fax:260-726-3406
Practice Address - Street 1:603 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371
Practice Address - Country:US
Practice Address - Phone:260-726-3404
Practice Address - Fax:260-726-3406
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001972A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN191780AMedicare ID - Type Unspecified
U73737Medicare UPIN