Provider Demographics
NPI:1083633747
Name:STEFANO, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:STEFANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 3RD ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2669
Mailing Address - Country:US
Mailing Address - Phone:951-278-1112
Mailing Address - Fax:951-278-1181
Practice Address - Street 1:1665 3RD ST
Practice Address - Street 2:SUITE E
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2669
Practice Address - Country:US
Practice Address - Phone:951-278-1112
Practice Address - Fax:951-278-1431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0208050Medicare PIN