Provider Demographics
NPI:1316274285
Name:STUBBLEFIELD, JARED (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:STUBBLEFIELD
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 1:1689 CROWN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6314
Mailing Address - Country:US
Mailing Address - Phone:717-945-2192
Mailing Address - Fax:717-650-2547
Practice Address - Street 1:1689 CROWN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6314
Practice Address - Country:US
Practice Address - Phone:717-945-2192
Practice Address - Fax:717-650-2547
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31451111N00000X
PADC010295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC010295OtherPENNSYLVANIA STATE CHIROPRACTIC BOARD
CADC-31451OtherSTATE LICENSE