Provider Demographics
NPI:1124028105
Name:STILLWAGON, WARD STERLING (DC)
Entity Type:Individual
Prefix:DR
First Name:WARD
Middle Name:STERLING
Last Name:STILLWAGON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 DRY RUN RD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1226
Mailing Address - Country:US
Mailing Address - Phone:724-258-6506
Mailing Address - Fax:
Practice Address - Street 1:767 DRY RUN RD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1226
Practice Address - Country:US
Practice Address - Phone:724-258-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003439L111N00000X
MI2301006791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011986050001Medicaid
PA202149OtherUPMC
OH251631082-00OtherOHIO WORK COMP
PA1041073OtherCIGNA
PA202149OtherUPMC