Provider Demographics
NPI:1578611273
Name:STUCKY, JON L (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:L
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 1:130 N 800 E
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-1150
Mailing Address - Country:US
Mailing Address - Phone:435-245-3500
Mailing Address - Fax:435-755-2913
Practice Address - Street 1:130 N 800 E
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-1150
Practice Address - Country:US
Practice Address - Phone:435-245-3500
Practice Address - Fax:435-755-2913
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT285738-1202111N00000X
WI3110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU48620Medicare UPIN
UT000056245Medicare ID - Type Unspecified