Provider Demographics
NPI:1851449250
Name:TRIAD SPORTS AND FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TRIAD SPORTS AND FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCCLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-833-4600
Mailing Address - Street 1:225 S MERAMEC AVE STE 920T
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3598
Mailing Address - Country:US
Mailing Address - Phone:314-833-4600
Mailing Address - Fax:
Practice Address - Street 1:225 S MERAMEC AVE STE 920T
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3598
Practice Address - Country:US
Practice Address - Phone:314-833-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty