Provider Demographics
NPI:1376501536
Name:STIRES, JEFFERY B (DC)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:B
Last Name:STIRES
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 1:13601 N 19TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1672
Mailing Address - Country:US
Mailing Address - Phone:602-993-5458
Mailing Address - Fax:602-993-5402
Practice Address - Street 1:13601 N 19TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1672
Practice Address - Country:US
Practice Address - Phone:602-993-5458
Practice Address - Fax:602-993-5402
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1285996843OtherNPI
AZZDC5131Medicare PIN
AZU48553Medicare UPIN