Provider Demographics
NPI:1013340272
Name:DELUCA-STAFFORD, JENNIFER L (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:DELUCA-STAFFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6934 BEACH DR SW
Mailing Address - Street 2:STE 2
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-5797
Mailing Address - Country:US
Mailing Address - Phone:910-575-2225
Mailing Address - Fax:910-575-2275
Practice Address - Street 1:6934 BEACH DR SW
Practice Address - Street 2:STE 2
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-5797
Practice Address - Country:US
Practice Address - Phone:910-575-2225
Practice Address - Fax:910-575-2275
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3282OtherLICESE NUMBER NC