Provider Demographics
NPI:1043272412
Name:RITTENOUR, STEPHANIE ALEXIS (DC CACCP)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ALEXIS
Last Name:RITTENOUR
Suffix:
Gender:F
Credentials:DC CACCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4033
Mailing Address - Country:US
Mailing Address - Phone:978-462-0263
Mailing Address - Fax:978-462-0265
Practice Address - Street 1:95 PARKER ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-4033
Practice Address - Country:US
Practice Address - Phone:978-462-0263
Practice Address - Fax:978-462-0265
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2819111N00000X
PA009360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1600311OtherMASS HEALTH
MA5160922OtherCIGNA
7847472OtherAETNA
MAAA11010OtherHARVARD PILGRIM
MA664730OtherACN
MAY36962OtherBCBS
MAU96559Medicare UPIN
MA5160922OtherCIGNA