Provider Demographics
NPI:1699864108
Name:STEPHENS, JASON TODD (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:TODD
Last Name:STEPHENS
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 1:225 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2231
Mailing Address - Country:US
Mailing Address - Phone:715-234-9876
Mailing Address - Fax:715-234-0855
Practice Address - Street 1:2021 CENEX DR
Practice Address - Street 2:SUITE E
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1891
Practice Address - Country:US
Practice Address - Phone:715-234-9876
Practice Address - Fax:715-234-0855
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4541111N00000X
CO4257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC48183Medicare ID - Type UnspecifiedCHIROPRACTOR
WI356790005Medicare UPIN