Provider Demographics
NPI:1376667196
Name:STENZEL CHIROPRACTIC
Entity Type:Organization
Organization Name:STENZEL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-282-3636
Mailing Address - Street 1:204 W MARKET ST
Mailing Address - Street 2:PO BOX 167
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-1029
Mailing Address - Country:US
Mailing Address - Phone:618-282-3636
Mailing Address - Fax:618-282-3635
Practice Address - Street 1:204 W MARKET ST
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-1029
Practice Address - Country:US
Practice Address - Phone:618-282-3636
Practice Address - Fax:618-282-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208610Medicare PIN