Provider Demographics
NPI:1831250620
Name:HANDSCHIN, JEREMIAH PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:PAUL
Last Name:HANDSCHIN
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:PO BOX 12743
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-2743
Mailing Address - Country:US
Mailing Address - Phone:307-699-3170
Mailing Address - Fax:
Practice Address - Street 1:4030 W LAKE CREEK DR
Practice Address - Street 2:STE. 9
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9689
Practice Address - Country:US
Practice Address - Phone:307-699-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY681111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW24558OtherPTAN