Provider Demographics
NPI:1891076881
Name:STITT, JACLYN RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:RENEE
Last Name:STITT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6094 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2528
Mailing Address - Country:US
Mailing Address - Phone:219-313-3526
Mailing Address - Fax:
Practice Address - Street 1:6094 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2528
Practice Address - Country:US
Practice Address - Phone:219-313-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002577A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor