Provider Demographics
NPI:1609899186
Name:MCCLEARY, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCCLEARY
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 1:225 S MERAMEC AVE
Mailing Address - Street 2:SUITE 920T
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3511
Mailing Address - Country:US
Mailing Address - Phone:314-833-4600
Mailing Address - Fax:314-833-4601
Practice Address - Street 1:225 S MERAMEC AVE
Practice Address - Street 2:SUITE 920T
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3511
Practice Address - Country:US
Practice Address - Phone:314-833-4600
Practice Address - Fax:314-833-4601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006000482111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV08670Medicare UPIN
MO000025947Medicare Oscar/Certification