Provider Demographics
NPI:1225112774
Name:PINTI, STEPHEN LEE (D C)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:PINTI
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CIMARRON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4374
Mailing Address - Country:US
Mailing Address - Phone:304-623-5551
Mailing Address - Fax:304-623-5552
Practice Address - Street 1:135 CIMARRON RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4374
Practice Address - Country:US
Practice Address - Phone:304-623-5551
Practice Address - Fax:304-623-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0132236000Medicaid
WVU65305Medicare UPIN
WVPI0819161Medicare ID - Type Unspecified