Provider Demographics
NPI:1851434112
Name:ESTNER, STEPHEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:ESTNER
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 1:1039 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5135
Mailing Address - Country:US
Mailing Address - Phone:401-275-2225
Mailing Address - Fax:401-275-0620
Practice Address - Street 1:1039 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-5135
Practice Address - Country:US
Practice Address - Phone:401-275-2225
Practice Address - Fax:401-275-0620
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI00448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66503Medicare UPIN