Provider Demographics
NPI:1750414934
Name:PAMELA STIEFVATER
Entity type:Organization
Organization Name:PAMELA STIEFVATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:STIEFVATER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-385-4061
Mailing Address - Street 1:430 OLD BASS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-2724
Mailing Address - Country:US
Mailing Address - Phone:508-385-4061
Mailing Address - Fax:
Practice Address - Street 1:430 OLD BASS RIVER RD
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2724
Practice Address - Country:US
Practice Address - Phone:508-385-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1608851Medicaid
MAY39488OtherBLUE CROSS GROUP#
MA1608851Medicaid