Provider Demographics
NPI:1720270903
Name:SUTHERLAND, JENNIFER KAYE (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAYE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KAYE
Other - Last Name:LUKENBILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5675 N PINTAIL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-6592
Mailing Address - Country:US
Mailing Address - Phone:573-303-2504
Mailing Address - Fax:
Practice Address - Street 1:2516 FORUM BLVD
Practice Address - Street 2:STE 102
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5405
Practice Address - Country:US
Practice Address - Phone:573-445-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor