Provider Demographics
NPI:1588854228
Name:MAVISSAKALIAN, STEPHAN M (DC)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:M
Last Name:MAVISSAKALIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E WILBETH RD
Mailing Address - Street 2:APT 4
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3445
Mailing Address - Country:US
Mailing Address - Phone:330-773-7400
Mailing Address - Fax:
Practice Address - Street 1:708 E WILBETH RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3445
Practice Address - Country:US
Practice Address - Phone:330-773-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor