Individual
JACK SAILOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2206 LUCAS AVE UNIT 508, SAINT LOUIS, MO 63103-1555
(314) 307-4197
Mailing address
2206 LUCAS AVE UNIT 508, SAINT LOUIS, MO 63103-1555
(314) 307-4197
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
P059173009
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P059173009
CERTIFIED ATHLETIC TRAINER
MO
Enumeration date
10/10/2014
Last updated
10/10/2014
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