Provider Demographics
NPI:1770639551
Name:JERRY T STUCKEY DC PA
Entity Type:Organization
Organization Name:JERRY T STUCKEY DC PA
Other - Org Name:AMERICAN CHIROPRACTIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-821-7200
Mailing Address - Street 1:7407 YORK RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7504
Mailing Address - Country:US
Mailing Address - Phone:410-821-7200
Mailing Address - Fax:
Practice Address - Street 1:7407 YORK RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7504
Practice Address - Country:US
Practice Address - Phone:410-821-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01932111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD478MMedicare PIN