Provider Demographics
NPI:1316946155
Name:OLENJACK, DAWN C (DC)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:C
Last Name:OLENJACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4600 S LINDBERGH BLVD
Mailing Address - Street 2:#3
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1812
Mailing Address - Country:US
Mailing Address - Phone:314-729-0027
Mailing Address - Fax:314-729-1015
Practice Address - Street 1:4600 S LINDBERGH BLVD
Practice Address - Street 2:#3
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1812
Practice Address - Country:US
Practice Address - Phone:314-729-0027
Practice Address - Fax:314-729-1015
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110100OtherBLUE CROSS BLUE SHIELD