Provider Demographics
NPI:1790833085
Name:STEKETEE, STANFORD MARK (DC)
Entity Type:Individual
Prefix:
First Name:STANFORD
Middle Name:MARK
Last Name:STEKETEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:S.
Other - Middle Name:MARK
Other - Last Name:STEKETEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:104 SOUTH MAIN STREET
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-0566
Mailing Address - Country:US
Mailing Address - Phone:406-225-3111
Mailing Address - Fax:406-225-3444
Practice Address - Street 1:104 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:MT
Practice Address - Zip Code:59632-0566
Practice Address - Country:US
Practice Address - Phone:406-225-3111
Practice Address - Fax:406-225-3444
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000040723OtherBLUE CROSS BLUE SHIELD
MT81039OtherEBMS
MT0000164322Medicaid