Provider Demographics
NPI:1609088855
Name:STUCKEY FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:STUCKEY FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-758-1700
Mailing Address - Street 1:2510 MINERAL POINT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2716
Mailing Address - Country:US
Mailing Address - Phone:608-758-1700
Mailing Address - Fax:
Practice Address - Street 1:2510 MINERAL POINT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2716
Practice Address - Country:US
Practice Address - Phone:608-758-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty