Provider Demographics
NPI:1063509438
Name:STJERNHOLM, DEAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:A
Last Name:STJERNHOLM
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:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-1910
Mailing Address - Country:US
Mailing Address - Phone:970-468-9555
Mailing Address - Fax:970-468-0948
Practice Address - Street 1:1000 N. SUMMIT BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-468-9555
Practice Address - Fax:970-468-0948
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COK1013Medicare UPIN