Provider Demographics
NPI:1710066261
Name:STEWART, JEFFERY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DAVID
Last Name:STEWART
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 1:3472 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1203
Mailing Address - Country:US
Mailing Address - Phone:724-744-0020
Mailing Address - Fax:
Practice Address - Street 1:3472 ROUTE 130
Practice Address - Street 2:
Practice Address - City:HARRISON CITY
Practice Address - State:PA
Practice Address - Zip Code:15636-1203
Practice Address - Country:US
Practice Address - Phone:724-744-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2591111NR0400X
PADC004872L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation