Provider Demographics
NPI:1265533061
Name:JAFFE, STEPHEN GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GLENN
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3230 PROSPERITY CHURCH RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8251
Mailing Address - Country:US
Mailing Address - Phone:704-971-3275
Mailing Address - Fax:704-971-3276
Practice Address - Street 1:3230 PROSPERITY CHURCH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8251
Practice Address - Country:US
Practice Address - Phone:704-971-3275
Practice Address - Fax:704-971-3276
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3453111N00000X
FL8599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905289Medicaid
NC5905289Medicaid
NCV08404Medicare UPIN
2459077Medicare PIN