Provider Demographics
NPI:1811981707
Name:MULLIGAN, JAY P JR (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:P
Last Name:MULLIGAN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11872 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1800
Mailing Address - Country:US
Mailing Address - Phone:314-849-3040
Mailing Address - Fax:314-849-7279
Practice Address - Street 1:11872 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1800
Practice Address - Country:US
Practice Address - Phone:314-849-3040
Practice Address - Fax:314-849-7279
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005086111N00000X
NC1550111N00000X
FL5684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO250010OtherASHN
5086OtherALL
1329576OtherPRINCIPAL HEALTH CARE
3082849OtherCIGNA
5224OtherBCBS ALLIANCE
3082849OtherAMERICAN SPECIALTY HEALTH
MO250888OtherACN
000000010306OtherESSENCE HEALTHCARE
177379OtherHEALTHLINK PPO
177379OtherHEALTHLINK HMO
MO140968OtherGHP
4218073OtherAETNA
4218073OtherAETNA US HEALTHCARE
177379OtherCARPENTERS HL
4400465OtherMEDICARE COMPLETE
5224OtherBLUE CHOICE
MO350057134OtherRAILROAD MEDICARE
4400465OtherUNITED HEALTHCARE
177379OtherHEALTHLINK PPO