Healthcare Provider Details

I. General information

NPI: 1124271655
Provider Name (Legal Business Name): JACOB WILLIAM STEGMAIER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 N GALENA AVE SUITE 200
DIXON IL
61021-1568
US

IV. Provider business mailing address

841 N GALENA AVE SUITE 200
DIXON IL
61021-1568
US

V. Phone/Fax

Practice location:
  • Phone: 815-285-2273
  • Fax: 815-285-2276
Mailing address:
  • Phone: 815-285-2273
  • Fax: 815-285-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012199
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: