Provider Demographics
NPI:1396990206
Name:MEADOR-STONE, JENNIFER ANNE (NCCAOM DIPLOMAT LAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:MEADOR-STONE
Suffix:
Gender:F
Credentials:NCCAOM DIPLOMAT LAC
Other - Prefix:
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Mailing Address - Street 1:5610 CRAWFORDSVILLE RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224
Mailing Address - Country:US
Mailing Address - Phone:317-240-8009
Mailing Address - Fax:317-240-1040
Practice Address - Street 1:888 AUTO MALL RD.
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401
Practice Address - Country:US
Practice Address - Phone:812-353-2700
Practice Address - Fax:812-353-2701
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ININ #84000001171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist