Provider Demographics
NPI:1326117987
Name:STUCKY, JASON QUINN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:QUINN
Last Name:STUCKY
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 1:11090 OLD ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4740
Mailing Address - Country:US
Mailing Address - Phone:770-667-3382
Mailing Address - Fax:770-667-8177
Practice Address - Street 1:11090 OLD ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4740
Practice Address - Country:US
Practice Address - Phone:770-667-3382
Practice Address - Fax:770-667-8177
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU80905Medicare UPIN
GA35ZCGBDMedicare ID - Type Unspecified