Provider Demographics
NPI:1467099309
Name:STITTLEBURG, JORDAN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE
Last Name:STITTLEBURG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1138
Mailing Address - Country:US
Mailing Address - Phone:517-398-5600
Mailing Address - Fax:
Practice Address - Street 1:1021 BERRY AVE
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3400
Practice Address - Country:US
Practice Address - Phone:608-372-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-5022111N00000X
WI5207-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor