MEDICARE: JEROME PATRICK STETZ 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	1070	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	311440183-00	OTHER	OH	BUREAU OF WORKERS' COMPEN

General Provider Information

NPI Number	:	1043297674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME PATRICK STETZ D.C.

Provider Business Mailing Address
First Line	:	1057 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2609
Country	:	US
Telephone Number	:	614-459-5400
Fax Number	:	614-459-6353

Provider Business Practice Location Address
First Line	:	1057 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2609
Country	:	US
Telephone Number	:	614-459-5400
Fax Number	:	614-459-6353

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/08/2007

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