Provider Demographics
NPI:1992418701
Name:LITTLEFIELD, JARED DOUGLAS (DC)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:DOUGLAS
Last Name:LITTLEFIELD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 ANNABROOK PARK DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-8410
Mailing Address - Country:US
Mailing Address - Phone:314-448-2431
Mailing Address - Fax:
Practice Address - Street 1:5252 MEXICO ROAD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1032
Practice Address - Country:US
Practice Address - Phone:636-978-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022049173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor