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General NPI Number Information
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NPI Number | 1255513966
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Entity Type | Organization
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Legal Business Name | JAMES P. STUPAK, D.C., PLC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 05/04/2008
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Provider Practice Location Address
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Address Line | 580 CRAIG DR # 8-133
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City | PERRYSBURG
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State | OH
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Zip | 43551-1778
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Country | US
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Telephone | 316-992-6338
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Fax |
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Provider Business Mailing Address
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Address Line | 580 CRAIG DR # 8-133
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City | PERRYSBURG
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State | OH
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Zip | 43551-1778
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Country | US
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Telephone | 316-992-6338
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES P STUPAK
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Credential | D.C.
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Telephone | 316-992-6338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2301009357
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License Number State | MI
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