Provider Demographics
NPI:1043228968
Name:STABIN, THEA F (DC)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:F
Last Name:STABIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 ORADELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1722
Mailing Address - Country:US
Mailing Address - Phone:201-599-1370
Mailing Address - Fax:201-599-1371
Practice Address - Street 1:546 ORADELL AVENUE
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1722
Practice Address - Country:US
Practice Address - Phone:201-599-1370
Practice Address - Fax:201-599-1371
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T45738Medicare UPIN
NJ536577Medicare ID - Type Unspecified