Provider Demographics
NPI:1629562244
Name:BRETT C STEFAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BRETT C STEFAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-302-4136
Mailing Address - Street 1:2879 E DUBLIN GRANVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4063
Mailing Address - Country:US
Mailing Address - Phone:614-898-0787
Mailing Address - Fax:
Practice Address - Street 1:2879 E DUBLIN GRANVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4063
Practice Address - Country:US
Practice Address - Phone:614-898-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2987782Medicaid