Provider Demographics
NPI:1215374061
Name:MARTELL, STEPHANIE RACHEL (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:RACHEL
Last Name:MARTELL
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 1:2503 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-4321
Mailing Address - Country:US
Mailing Address - Phone:715-529-1705
Mailing Address - Fax:
Practice Address - Street 1:21080 OLINDA TRL N
Practice Address - Street 2:
Practice Address - City:SCANDIA
Practice Address - State:MN
Practice Address - Zip Code:55073-9492
Practice Address - Country:US
Practice Address - Phone:715-529-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1740325299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor