Provider Demographics
NPI:1497802011
Name:DEVANEY, JACQUELINE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANN
Last Name:DEVANEY
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 1:8108 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-4364
Mailing Address - Country:US
Mailing Address - Phone:816-786-2623
Mailing Address - Fax:816-786-2623
Practice Address - Street 1:8108 E 91ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-4364
Practice Address - Country:US
Practice Address - Phone:816-786-2623
Practice Address - Fax:816-786-2623
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-1412481OtherEIN
MO000C750Medicare UPIN