Physician Compare National (NPI:1669521324)

HEALTHCARE PROVIDER: STEPHAN PAUL EDISS D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1669521324
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0446411268
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120420000593
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	EDISS
	Individual professional last name
Provider First Name	STEPHAN
	Individual professional first name
Provider Middle Name	P
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LOS ANGELES COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1330 E RICHARDS ST
	Group Practice or individual's line 1 address
City	DOUGLAS
	Group Practice or individual's city
State	WY
	Group Practice or individual's state
Zip Code	826332951
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M