Provider Demographics
NPI:1609304104
Name:WILKERSON, JEANETTA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANETTA
Middle Name:MARIE
Last Name:WILKERSON
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 1:320 BROOKES DR STE 237
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2733
Mailing Address - Country:US
Mailing Address - Phone:314-225-8810
Mailing Address - Fax:
Practice Address - Street 1:320 BROOKES DR STE 237
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2733
Practice Address - Country:US
Practice Address - Phone:314-225-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016039732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor