Healthcare Provider Details

I. General information

NPI: 1619211372
Provider Name (Legal Business Name): STEPHEN WILLIAM ESDINSKY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 OLDE 8 RD
NORTHFIELD OH
44067-2060
US

IV. Provider business mailing address

9207 HARROW DR
PARMA OH
44129-1734
US

V. Phone/Fax

Practice location:
  • Phone: 330-467-6100
  • Fax:
Mailing address:
  • Phone: 440-539-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4317
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: