Provider Demographics
NPI:1558749853
Name:FAMILY WELLNESS CHIROPRACTIC
Entity Type:Organization
Organization Name:FAMILY WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-607-1038
Mailing Address - Street 1:2109 WOODLET PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5034
Mailing Address - Country:US
Mailing Address - Phone:314-607-1038
Mailing Address - Fax:
Practice Address - Street 1:2109 WOODLET PARK DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5034
Practice Address - Country:US
Practice Address - Phone:314-607-2231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005014052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1649471988OtherINDIVIDUAL NPI