Healthcare Provider Details

I. General information

NPI: 1063514743
Provider Name (Legal Business Name): STEPHEN STANLEY DOUDNA II D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NORTH ST SUITE #1
CALDWELL OH
43724-1217
US

IV. Provider business mailing address

PO BOX 114
CALDWELL OH
43724-0114
US

V. Phone/Fax

Practice location:
  • Phone: 740-732-4242
  • Fax: 740-732-9980
Mailing address:
  • Phone: 740-732-4242
  • Fax: 740-732-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1398
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: