Healthcare Provider Details

I. General information

NPI: 1255695029
Provider Name (Legal Business Name): CHRISTOPHER BENNETT STALLING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 07/21/2022
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S UNION AVE STE 100
ALLIANCE OH
44601-4355
US

IV. Provider business mailing address

1900 S UNION AVE STE 100
ALLIANCE OH
44601-4355
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-6500
  • Fax:
Mailing address:
  • Phone: 330-596-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number125.069775
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: