Provider Demographics
NPI:1477795490
Name:5 STAR CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:5 STAR CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-500-8457
Mailing Address - Street 1:1601 E 9TH ST
Mailing Address - Street 2:STE. E
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-2763
Mailing Address - Country:US
Mailing Address - Phone:816-500-8457
Mailing Address - Fax:
Practice Address - Street 1:1601 E 9TH ST
Practice Address - Street 2:STE. E
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2763
Practice Address - Country:US
Practice Address - Phone:816-500-8457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070007093302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization