Provider Demographics
NPI:1265997498
Name:STACHOWICZ, JOSEF BERNARD (DC)
Entity type:Individual
Prefix:
First Name:JOSEF
Middle Name:BERNARD
Last Name:STACHOWICZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOSEF
Other - Middle Name:B
Other - Last Name:STACHOWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:896 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3738
Mailing Address - Country:US
Mailing Address - Phone:231-773-4716
Mailing Address - Fax:
Practice Address - Street 1:896 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3738
Practice Address - Country:US
Practice Address - Phone:231-773-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor