Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2021037406 | MO |
NPI | 1144980319 |
---|---|
Provider Name | Jacqueline Jimenez |
First Address | Lees Summit, MO 64063-2340 |
Second Address | Lees Summit, MO 64063-2340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2021 |
Last Update Date | 29/12/2021 |