Provider Demographics
NPI:1053335448
Name:STEPHAN, JINNIFER MELISSA (DC)
Entity Type:Individual
Prefix:
First Name:JINNIFER
Middle Name:MELISSA
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330A S LAWRENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-9219
Mailing Address - Country:US
Mailing Address - Phone:352-473-9777
Mailing Address - Fax:
Practice Address - Street 1:330A S LAWRENCE BLVD
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9219
Practice Address - Country:US
Practice Address - Phone:352-473-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009654111N00000X
FL9215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor