MEDICARE: DR. JEFFERY E STICKEL 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	A05939	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53617	OTHER	IA	WELLMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548439193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY E STICKEL D.C.

Provider Business Mailing Address
First Line	:	2913 INGERSOLL AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-4014
Country	:	US
Telephone Number	:	515-255-3021
Fax Number	:	515-274-8732

Provider Business Practice Location Address
First Line	:	2913 INGERSOLL AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-4014
Country	:	US
Telephone Number	:	515-255-3021
Fax Number	:	515-274-8732

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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Directions to “ DR. JEFFERY E STICKEL D.C.” Practice Location

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