Provider Demographics
NPI:1538276944
Name:EBERHART, JEANENE (DC)
Entity type:Individual
Prefix:DR
First Name:JEANENE
Middle Name:
Last Name:EBERHART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 N RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-9753
Mailing Address - Country:US
Mailing Address - Phone:417-782-0330
Mailing Address - Fax:417-782-9339
Practice Address - Street 1:3013 N RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-9753
Practice Address - Country:US
Practice Address - Phone:417-782-0330
Practice Address - Fax:417-782-9339
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT91073Medicare UPIN
MO000032452Medicare ID - Type Unspecified
MO000032452Medicare PIN
MOMA1109001Medicare PIN