Provider Demographics
NPI:1790957322
Name:STAGS FAMILY CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:STAGS FAMILY CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STEIGERWALT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-934-2335
Mailing Address - Street 1:35840 CHESTER RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1240
Mailing Address - Country:US
Mailing Address - Phone:440-934-2335
Mailing Address - Fax:440-934-2363
Practice Address - Street 1:35840 CHESTER RD
Practice Address - Street 2:SUITE J
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1240
Practice Address - Country:US
Practice Address - Phone:440-934-2335
Practice Address - Fax:440-934-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3557111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHST9350311Medicare PIN