Healthcare Provider Details

I. General information

NPI: 1720115926
Provider Name (Legal Business Name): JONATHAN DAVID STEIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FINNELL DR
WEYMOUTH MA
02188-1110
US

IV. Provider business mailing address

111 WILLARD ST STE 2A
QUINCY MA
02169-1200
US

V. Phone/Fax

Practice location:
  • Phone: 781-682-9755
  • Fax: 781-335-7851
Mailing address:
  • Phone: 617-471-5053
  • Fax: 617-984-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number523
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: