MEDICARE: DR. JASON JOHN STADTHER 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	3945DC	MN

General Provider Information

NPI Number	:	1548218019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON JOHN STADTHER D.C.

Provider Business Mailing Address
First Line	:	2781 FREEWAY BLVD
Second Line	:	SUITE 160
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1753
Country	:	US
Telephone Number	:	763-244-8022
Fax Number	:	763-244-8021

Provider Business Practice Location Address
First Line	:	2781 FREEWAY BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1753
Country	:	US
Telephone Number	:	763-244-8022
Fax Number	:	763-244-8021

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/11/2018

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