Provider Demographics
NPI:1427413996
Name:STONEBRIDGE CLINICS, PLLC
Entity Type:Organization
Organization Name:STONEBRIDGE CLINICS, PLLC
Other - Org Name:STONEBRIDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:OTEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-535-3800
Mailing Address - Street 1:7204 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3430
Mailing Address - Country:US
Mailing Address - Phone:469-535-3800
Mailing Address - Fax:
Practice Address - Street 1:7204 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3430
Practice Address - Country:US
Practice Address - Phone:469-535-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303877YT4EMedicare PIN