Provider Demographics
NPI:1578768602
Name:JONES, WENDI LORRAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDI
Middle Name:LORRAINE
Last Name:JONES
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 1:2007 LUNENBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-8123
Mailing Address - Country:US
Mailing Address - Phone:636-721-4872
Mailing Address - Fax:
Practice Address - Street 1:918 HEMSATH ROAD SUITE 102B
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-949-2771
Practice Address - Fax:636-949-2771
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2003011569111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMO2003011569OtherSTATE LICENSE
MO68-0558394Medicare ID - Type UnspecifiedFED ID