Provider Demographics
NPI:1720115926
Name:STEIN, JONATHAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:STEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 WILLARD ST
Mailing Address - Street 2:STE 2A
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1200
Mailing Address - Country:US
Mailing Address - Phone:617-471-5053
Mailing Address - Fax:617-984-0636
Practice Address - Street 1:75 FINNELL DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-1110
Practice Address - Country:US
Practice Address - Phone:781-682-9755
Practice Address - Fax:781-335-7851
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY3537701Medicare PIN