Provider Demographics
NPI:1437346715
Name:STENGEL CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:STENGEL CHIROPRACTIC, INC.
Other - Org Name:WILLIS CHIROMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:STENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-248-7040
Mailing Address - Street 1:1521 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3570
Mailing Address - Country:US
Mailing Address - Phone:843-248-7040
Mailing Address - Fax:843-248-7538
Practice Address - Street 1:1521 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3570
Practice Address - Country:US
Practice Address - Phone:843-248-7040
Practice Address - Fax:843-248-7538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2009Medicaid
SCU59802-8439Medicare UPIN