Provider Demographics
NPI:1255513966
Name:JAMES P. STUPAK, D.C., PLC
Entity type:Organization
Organization Name:JAMES P. STUPAK, D.C., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:STUPAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-992-6338
Mailing Address - Street 1:580 CRAIG DR # 8-133
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1778
Mailing Address - Country:US
Mailing Address - Phone:316-992-6338
Mailing Address - Fax:
Practice Address - Street 1:580 CRAIG DR # 8-133
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1778
Practice Address - Country:US
Practice Address - Phone:316-992-6338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009357261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center