Provider Demographics
NPI:1831123207
Name:STEPHAN, CARTER JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:JAY
Last Name:STEPHAN
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 1:1080A CHAMBERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8457
Mailing Address - Country:US
Mailing Address - Phone:717-334-5566
Mailing Address - Fax:717-337-9102
Practice Address - Street 1:1080A CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-8457
Practice Address - Country:US
Practice Address - Phone:717-334-5566
Practice Address - Fax:717-337-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004668L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1713610Medicaid
052806Medicare ID - Type Unspecified
U87788Medicare UPIN