Provider Demographics
NPI:1205927951
Name:MEVERDEN, JAY J (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:J
Last Name:MEVERDEN
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 1:8707 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-8634
Mailing Address - Country:US
Mailing Address - Phone:715-848-1772
Mailing Address - Fax:
Practice Address - Street 1:2600 STEWART AVE
Practice Address - Street 2:SUITE 154
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4148
Practice Address - Country:US
Practice Address - Phone:715-848-4088
Practice Address - Fax:715-842-2496
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1673111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38770900Medicaid
WI75184Medicare ID - Type Unspecified
WI38770900Medicaid