Provider Demographics
NPI:1689730830
Name:HUCK, JEFFERY LINN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:LINN
Last Name:HUCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N. DESLOGE DR.
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601
Mailing Address - Country:US
Mailing Address - Phone:573-518-0608
Mailing Address - Fax:573-518-0635
Practice Address - Street 1:1110 N DESLOGE DR
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-2937
Practice Address - Country:US
Practice Address - Phone:573-518-0608
Practice Address - Fax:573-518-0635
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000144179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1861165636OtherFIRSTHEALTH
MO128276OtherBLUECROSSBLUESHIELD
MO453997OtherHEALTHLINK
MO4400137OtherUNITEDHEALTHCARE
MO000031846Medicare ID - Type Unspecified
MO128276OtherBLUECROSSBLUESHIELD