Healthcare Provider Details

I. General information

NPI: 1407911316
Provider Name (Legal Business Name): STEPHEN M ERLE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380A PLANK RD STE A
FREDERICKSBURG VA
22401-4927
US

IV. Provider business mailing address

2380A PLANK RD STE A
FREDERICKSBURG VA
22401-4927
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-1303
  • Fax: 540-373-6061
Mailing address:
  • Phone: 540-373-1303
  • Fax: 540-373-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104556636
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: