Provider Demographics
NPI:1114126570
Name:JAY J MEVERDEN
Entity Type:Organization
Organization Name:JAY J MEVERDEN
Other - Org Name:MEVERDEN SPORTS AND FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEVERDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-848-4088
Mailing Address - Street 1:2600 STEWART AVE STE 154
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-1404
Mailing Address - Country:US
Mailing Address - Phone:714-848-4088
Mailing Address - Fax:715-842-2497
Practice Address - Street 1:2600 STEWART AVE STE 154
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-1404
Practice Address - Country:US
Practice Address - Phone:714-848-4088
Practice Address - Fax:715-842-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1673111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty