Healthcare Provider Details

I. General information

NPI: 1245600881
Provider Name (Legal Business Name): KEVIN STANEK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W US HIGHWAY 2
NORWAY MI
49870-1175
US

IV. Provider business mailing address

415 W US HIGHWAY 2
NORWAY MI
49870-1175
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-5871
  • Fax: 906-563-5969
Mailing address:
  • Phone: 906-563-5871
  • Fax: 906-563-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009885
License Number StateMI

VIII. Authorized Official

Name: KEVIN LEE STANEK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 906-563-5871