Provider Demographics
NPI:1124244645
Name:DRURY, JENNIFER LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:DRURY
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 1:37 MEYER LN
Mailing Address - Street 2:P.O. BOX 197
Mailing Address - City:BLOOMSDALE
Mailing Address - State:MO
Mailing Address - Zip Code:63627-9138
Mailing Address - Country:US
Mailing Address - Phone:573-483-3733
Mailing Address - Fax:573-483-3735
Practice Address - Street 1:37 MEYER LN
Practice Address - Street 2:
Practice Address - City:BLOOMSDALE
Practice Address - State:MO
Practice Address - Zip Code:63627-9138
Practice Address - Country:US
Practice Address - Phone:573-483-3733
Practice Address - Fax:573-483-3735
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006037923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO311205385Medicare PIN