Provider Demographics
NPI:1700945946
Name:STENDER, JEREMY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PAUL
Last Name:STENDER
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 1:824 S HASTINGS WAY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3426
Mailing Address - Country:US
Mailing Address - Phone:715-835-1122
Mailing Address - Fax:715-835-0807
Practice Address - Street 1:824 S HASTINGS WAY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3426
Practice Address - Country:US
Practice Address - Phone:715-835-1122
Practice Address - Fax:715-835-0807
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3733-012111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38935400Medicaid
WIU83424Medicare UPIN