Provider Demographics
NPI:1639112808
Name:PENDELL, STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:PENDELL
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 1:131 N POINT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-8366
Mailing Address - Country:US
Mailing Address - Phone:937-444-1166
Mailing Address - Fax:888-757-7699
Practice Address - Street 1:131 N POINT DR
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8366
Practice Address - Country:US
Practice Address - Phone:937-444-1166
Practice Address - Fax:888-315-2865
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2180507Medicaid
OH0878292Medicare PIN