Individual provider Active NPI

Jennifer Leary

  • Chiropractor
  • Saint Louis, MO
National Provider Identifier
1225994221
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2025053733 Issued in MO
Practice address
12636 Lamplighter Square SHPG Ctr
Saint Louis, MO 63128-2746
Phone
(856) 430-4531
NPI assigned
Jan 2, 2026
Last updated
May 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2025053733 MO Primary

Addresses

Primary practice location

12636 Lamplighter Square SHPG Ctr
Saint Louis, MO 63128-2746

Mailing address

12636 Lamplighter Square SHPG Ctr
Saint Louis, MO 63128-2746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260209001222 MO Practitioner - Chiropractic 7113406307 Practice locations: Saint Louis, MO

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12636 Lamplighter Square SHPG Ctr
Saint Louis, MO 63128-2746
Phone (856) 430-4531

12906 Autumn View Dr
Saint Louis, MO 63146-4331

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2025053733MOMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Rapha Chiropractic Chiropractor CurrentSince Jan 1, 2026 Accepting new patients
Beutel Chiropractic & Wellness Center Chiropractor PastSince Jan 4, 2026 Accepting new patients

Locations

12636 Lamplighter Square Shpg Ctr
Saint Louis, MO 63128
Phone (314) 330-5773

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1767312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1225994221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12636 LAMPLIGHTER SQUARE SHPG CTR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12636 LAMPLIGHTER SQUARE SHPG CTR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282746",
            "telephone_number": "856-430-4531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEARY",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-01-02",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2025053733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.