Provider Demographics
NPI:1760578447
Name:STINSON, JEFFREY W (DC, BCAO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:STINSON
Suffix:
Gender:M
Credentials:DC, BCAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 HARTLAND PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515
Mailing Address - Country:US
Mailing Address - Phone:859-276-1123
Mailing Address - Fax:859-276-1151
Practice Address - Street 1:715 SHAKER DR STE 50
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-276-1123
Practice Address - Fax:859-276-1151
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100006090Medicaid
KY7100006090Medicaid