Provider Demographics
NPI:1518999879
Name:MARTIN, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MARTIN
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 1:1395 TRIAD CENTER DR, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7352
Mailing Address - Country:US
Mailing Address - Phone:636-443-3476
Mailing Address - Fax:618-654-6072
Practice Address - Street 1:1395 TRIAD CENTER DR, SUITE 1
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7352
Practice Address - Country:US
Practice Address - Phone:636-443-3476
Practice Address - Fax:618-654-6072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005039232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor