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General NPI Number Information
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NPI Number | 1699033621
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Entity Type | Organization
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Legal Business Name | MARK J STUBBENDIECK DC INC
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 780 E SMITH RD # A
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City | MEDINA
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State | OH
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Zip | 44256-2662
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Country | US
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Telephone | 330-725-4060
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Fax | 330-722-4582
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Provider Business Mailing Address
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Address Line | 197 N PARDEE ST
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City | WADSWORTH
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State | OH
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Zip | 44281-1541
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK STUBBENDIECK
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Credential | DC
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Telephone | 330-725-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 1935
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1935
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License Number State | OH
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