MEDICARE: JINNIFER MELISSA STEPHAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	009654	PA
2	111N00000X	Chiropractor	9215	FL

General Provider Information

NPI Number	:	1053335448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINNIFER MELISSA STEPHAN D.C.

Provider Business Mailing Address
First Line	:	330A S LAWRENCE BLVD
Second Line	:
City	:	KEYSTONE HEIGHTS
State	:	FL
Zip	:	32656-9219
Country	:	US
Telephone Number	:	352-473-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	330A S LAWRENCE BLVD
Second Line	:
City	:	KEYSTONE HEIGHTS
State	:	FL
Zip	:	32656-9219
Country	:	US
Telephone Number	:	352-473-9777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/05/2009

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