Provider Demographics
NPI:1285996843
Name:JEFFERY B. STIRES, D.C., P.C.
Entity type:Organization
Organization Name:JEFFERY B. STIRES, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STIRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-993-5458
Mailing Address - Street 1:13601 N 19TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1672
Mailing Address - Country:US
Mailing Address - Phone:602-993-5458
Mailing Address - Fax:602-993-5402
Practice Address - Street 1:13601 N 19TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1672
Practice Address - Country:US
Practice Address - Phone:602-993-5458
Practice Address - Fax:602-993-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1376501536OtherNPI
AZ1376501536OtherNPI
AZU48553Medicare UPIN