Provider Demographics
NPI:1992404396
Name:STUROS, JACK ROBERT (DC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:ROBERT
Last Name:STUROS
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 1:47964 MADELEINE ST
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2831
Mailing Address - Country:US
Mailing Address - Phone:906-370-2793
Mailing Address - Fax:
Practice Address - Street 1:47964 MADELEINE ST
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2831
Practice Address - Country:US
Practice Address - Phone:906-370-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor