Provider Demographics
NPI:1568425775
Name:GUMPENBERGER, STEPHEN GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GARY
Last Name:GUMPENBERGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:GARY
Other - Last Name:GUMPENBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:114 SCIOTO LANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:S BLOOMFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9332
Mailing Address - Country:US
Mailing Address - Phone:740-983-1936
Mailing Address - Fax:740-474-4941
Practice Address - Street 1:1015 S COURT ST
Practice Address - Street 2:SUITE A
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2143
Practice Address - Country:US
Practice Address - Phone:740-474-2921
Practice Address - Fax:740-474-4941
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000384125OtherANTHEM CIRCLEVILLE
OH2347151Medicaid
OH000000385990OtherANTHEM WILMINGTON
OHDD214OtherRAILROAD MCR
OH030554726027OtherCARESOURCE
OH7871398OtherAETNA
OHU95314Medicare UPIN
OH4107014Medicare PIN
OH7871398OtherAETNA