Provider Demographics
NPI:1871713362
Name:DR J L STUCKY CHIROPRACTOR PA
Entity type:Organization
Organization Name:DR J L STUCKY CHIROPRACTOR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:STUCKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-534-3502
Mailing Address - Street 1:349 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55964-1255
Mailing Address - Country:US
Mailing Address - Phone:507-534-3502
Mailing Address - Fax:
Practice Address - Street 1:349 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:MN
Practice Address - Zip Code:55964-1255
Practice Address - Country:US
Practice Address - Phone:507-534-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCERTIFICATENUMBER4111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN36185STOtherBLUE CROSS BLUE SHIELD OF
MN36185STOtherBLUE CROSS BLUE SHIELD OF