Provider Demographics
NPI:1811194798
Name:SCHTIERMAN, JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:SCHTIERMAN
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 1:614 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3641
Mailing Address - Country:US
Mailing Address - Phone:212-768-4078
Mailing Address - Fax:212-768-4038
Practice Address - Street 1:500 5TH AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10110-0002
Practice Address - Country:US
Practice Address - Phone:212-768-4078
Practice Address - Fax:212-768-4038
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor