Provider Demographics
NPI:1922359512
Name:PEDERSEN, JODI L (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 NE 83RD TER
Mailing Address - Street 2:#1021
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-7149
Mailing Address - Country:US
Mailing Address - Phone:406-799-8127
Mailing Address - Fax:
Practice Address - Street 1:8225 NE 83RD TER
Practice Address - Street 2:#1021
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-7149
Practice Address - Country:US
Practice Address - Phone:406-799-8127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012033593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor