Provider Demographics
NPI:1356328371
Name:PRENTICE, STEVEN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAY
Last Name:PRENTICE
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 1:1723 COLUMBUS AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-621-7555
Mailing Address - Fax:419-621-5597
Practice Address - Street 1:1723 COLUMBUS AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-621-7555
Practice Address - Fax:419-621-5597
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0229176Medicaid
OHPR0798941Medicare ID - Type Unspecified
OH0229176Medicaid