Provider Demographics
NPI:1720279227
Name:SHORT, STEPHEN JAY JR (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAY
Last Name:SHORT
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3675 20TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2480
Mailing Address - Country:US
Mailing Address - Phone:772-569-6402
Mailing Address - Fax:772-569-1955
Practice Address - Street 1:3675 20TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2480
Practice Address - Country:US
Practice Address - Phone:772-569-6402
Practice Address - Fax:772-569-1955
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLCH7742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55857Medicare UPIN