Provider Demographics
NPI:1679755086
Name:PETERHANS-RITT, STENA M (DC)
Entity Type:Individual
Prefix:DR
First Name:STENA
Middle Name:M
Last Name:PETERHANS-RITT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STENA
Other - Middle Name:
Other - Last Name:PETERHANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1610 S EUCLID AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3380
Mailing Address - Country:US
Mailing Address - Phone:989-684-8400
Mailing Address - Fax:989-684-8404
Practice Address - Street 1:1407 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3380
Practice Address - Country:US
Practice Address - Phone:989-684-8400
Practice Address - Fax:989-684-8404
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP50930Medicare PIN