Provider Demographics
NPI:1568621936
Name:STAMBAUGH CHIROPRACTIC INC
Entity Type:Organization
Organization Name:STAMBAUGH CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:STAMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-967-2243
Mailing Address - Street 1:24 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-1126
Mailing Address - Country:US
Mailing Address - Phone:740-967-2243
Mailing Address - Fax:740-967-2241
Practice Address - Street 1:24 MEADOW LN
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-1126
Practice Address - Country:US
Practice Address - Phone:740-967-2243
Practice Address - Fax:740-967-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8653866OtherCIGNA
OH4398150OtherAETNA
000000504078OtherBLUE CROSS & BLUE SHIELD
OH2069023Medicaid
000000504078OtherBLUE CROSS & BLUE SHIELD
OHST0854223Medicare UPIN