Provider Demographics
NPI:1467587667
Name:HOELSCHER, JACLYN L (DC)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:L
Last Name:HOELSCHER
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 1:6034 YOUNG DR
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-9103
Mailing Address - Country:US
Mailing Address - Phone:636-329-8774
Mailing Address - Fax:636-329-8977
Practice Address - Street 1:6034 YOUNG DR
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9103
Practice Address - Country:US
Practice Address - Phone:636-329-8774
Practice Address - Fax:636-329-8977
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003027783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO153320001OtherMEDICARE PTAN
MO571653OtherANTHEM
MO184456OtherBLUE CROSS BLUE SHIELD
MO4009837OtherCIGNA
MO663537OtherUNITED HEALTHCARE
MO571653OtherANTHEM