Healthcare Provider Details

I. General information

NPI: 1205927951
Provider Name (Legal Business Name): JAY J MEVERDEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 STEWART AVE SUITE 154
WAUSAU WI
54401-4148
US

IV. Provider business mailing address

8707 TOWNLINE RD
WAUSAU WI
54403-8634
US

V. Phone/Fax

Practice location:
  • Phone: 715-848-4088
  • Fax: 715-842-2496
Mailing address:
  • Phone: 715-848-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1673
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: