MEDICARE: DR. STEPHEN PENDELL DC

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	2774	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

General Provider Information

NPI Number	:	1639112808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN PENDELL DC

Provider Business Mailing Address
First Line	:	131 N POINT DR
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8366
Country	:	US
Telephone Number	:	937-444-1166
Fax Number	:	888-757-7699

Provider Business Practice Location Address
First Line	:	131 N POINT DR
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8366
Country	:	US
Telephone Number	:	937-444-1166
Fax Number	:	888-315-2865

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/16/2018

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