Provider Demographics
NPI:1396739371
Name:AMUNDSON-MULLINS, JENNIFER ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
Last Name:AMUNDSON-MULLINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:AMUNDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:104 NW STATE ROUTE 7 STE G
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2749
Mailing Address - Country:US
Mailing Address - Phone:816-220-0660
Mailing Address - Fax:816-220-1161
Practice Address - Street 1:104 NW STATE ROUTE 7 STE G
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2749
Practice Address - Country:US
Practice Address - Phone:816-220-0660
Practice Address - Fax:816-220-1161
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
431856727OtherTAX ID
431856727OtherTAX ID
MO00A978Medicare PIN