Provider Demographics
NPI:1154359222
Name:STUMBAUGH, JESSE ROY (DC)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ROY
Last Name:STUMBAUGH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-2401
Mailing Address - Country:US
Mailing Address - Phone:515-981-9208
Mailing Address - Fax:515-981-1155
Practice Address - Street 1:1300 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211
Practice Address - Country:US
Practice Address - Phone:515-981-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14854OtherWELLMARK BCBS
IA2453928Medicaid
IA14854OtherWELLMARK BCBS