Provider Demographics
NPI:1417042896
Name:CLEMONS, JEANNINE M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:M
Last Name:CLEMONS
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 1:1629 N. WARSON RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-429-2929
Mailing Address - Fax:314-429-4331
Practice Address - Street 1:1629 N. WARSON RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-429-2929
Practice Address - Fax:314-429-4331
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE-005796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO28803OtherBLUE CROSS/SHIELD
MO28803OtherBLUE CROSS/SHIELD