Provider Demographics
NPI:1386014983
Name:STAHL, SAMANTHA (DC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:STAHL
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 1:1995 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-9128
Mailing Address - Country:US
Mailing Address - Phone:317-745-5100
Mailing Address - Fax:317-745-1267
Practice Address - Street 1:1995 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9128
Practice Address - Country:US
Practice Address - Phone:317-745-5100
Practice Address - Fax:317-745-1267
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002849A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201337620Medicaid
IN201337620Medicaid
IN234040005Medicare PIN