Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3733-012 | WI |
NPI | 1700945946 |
---|---|
Provider Name | Dr. Jeremy Paul Stender |
First Address | Eau Claire, WI 54701-3426 |
Second Address | Eau Claire, WI 54701-3426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38935400 | (05) | WI |
U83424 | (02) | WI |