Provider Demographics
NPI:1952496002
Name:CAMDEN, JEANNE KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:KAY
Last Name:CAMDEN
Suffix:
Gender:F
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:RR 1 BOX 164
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63541-9749
Mailing Address - Country:US
Mailing Address - Phone:660-457-3283
Mailing Address - Fax:
Practice Address - Street 1:321 NORTH CLAY
Practice Address - Street 2:HWY 15 NORTH
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555
Practice Address - Country:US
Practice Address - Phone:660-216-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005001581111N00000X
IA06773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38606OtherWELLMARK BCBS
MO25820Medicare ID - Type Unspecified