Provider Demographics
NPI:1376697532
Name:STORMS, JEREMY DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DEAN
Last Name:STORMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:51 CAVALIER BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3966
Mailing Address - Country:US
Mailing Address - Phone:859-620-1325
Mailing Address - Fax:859-586-5109
Practice Address - Street 1:51 CAVALIER BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3966
Practice Address - Country:US
Practice Address - Phone:859-620-1325
Practice Address - Fax:859-586-5109
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4399OtherSTATE LICENSE #
KYP300030359Medicare PIN
KY4399OtherSTATE LICENSE #