Provider Demographics
NPI:1801144175
Name:JESENOVEC-STUMMA, NANCY JO (DC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:JESENOVEC-STUMMA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 W 1ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1310
Mailing Address - Country:US
Mailing Address - Phone:319-465-4663
Mailing Address - Fax:
Practice Address - Street 1:818 W 1ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1310
Practice Address - Country:US
Practice Address - Phone:319-465-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor