Provider Demographics
NPI:1548409121
Name:DR. MICHAEL C STAUB, PLC
Entity Type:Organization
Organization Name:DR. MICHAEL C STAUB, PLC
Other - Org Name:BONE AND JOINT WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:STAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-990-2663
Mailing Address - Street 1:7701 E INDIAN SCHOOL RD STE H
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4041
Mailing Address - Country:US
Mailing Address - Phone:480-990-2663
Mailing Address - Fax:480-941-2825
Practice Address - Street 1:10752 N 89TH PL # A-101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6730
Practice Address - Country:US
Practice Address - Phone:602-565-0825
Practice Address - Fax:480-941-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ21548Medicare PIN