Provider Demographics
NPI:1659314334
Name:MEISENHEIMER, JASON LEN (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEN
Last Name:MEISENHEIMER
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 1:1229 E AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772
Mailing Address - Country:US
Mailing Address - Phone:417-667-3699
Mailing Address - Fax:
Practice Address - Street 1:1229 E AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772
Practice Address - Country:US
Practice Address - Phone:417-667-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0009785Medicare ID - Type Unspecified
MOU57404Medicare UPIN