Provider Demographics
NPI:1467763524
Name:STINE CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:STINE CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-324-8888
Mailing Address - Street 1:400 N MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1417
Mailing Address - Country:US
Mailing Address - Phone:563-324-8888
Mailing Address - Fax:563-324-8888
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1417
Practice Address - Country:US
Practice Address - Phone:563-324-8888
Practice Address - Fax:563-324-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IB1811Medicare PIN