Provider Demographics
NPI:1992544357
Name:JENNIFER BRAND LLC
Entity type:Organization
Organization Name:JENNIFER BRAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:636-294-7555
Mailing Address - Street 1:2717 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7864
Mailing Address - Country:US
Mailing Address - Phone:636-294-7555
Mailing Address - Fax:
Practice Address - Street 1:2717 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7864
Practice Address - Country:US
Practice Address - Phone:636-294-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty