Provider Demographics
NPI:1346873080
Name:STETTER SPORT & SPINE LLC
Entity Type:Organization
Organization Name:STETTER SPORT & SPINE LLC
Other - Org Name:ACTIVE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-630-8468
Mailing Address - Street 1:27 PASCO AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1927
Mailing Address - Country:US
Mailing Address - Phone:812-423-9146
Mailing Address - Fax:
Practice Address - Street 1:915 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1855
Practice Address - Country:US
Practice Address - Phone:812-423-1496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty