Provider Demographics
NPI:1811142011
Name:DIETZ, STEPHANIE A (DC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:DIETZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E FINDLAY STREET
Mailing Address - Street 2:
Mailing Address - City:CAREY
Mailing Address - State:OH
Mailing Address - Zip Code:43316-1248
Mailing Address - Country:US
Mailing Address - Phone:419-396-1911
Mailing Address - Fax:419-396-1911
Practice Address - Street 1:221 E FINDLAY STREET
Practice Address - Street 2:
Practice Address - City:CAREY
Practice Address - State:OH
Practice Address - Zip Code:43316-1248
Practice Address - Country:US
Practice Address - Phone:419-396-1911
Practice Address - Fax:419-396-1911
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2983973Medicaid
OHDI4252351Medicare PIN
OHDI4252353Medicare PIN
OHDI4252352Medicare PIN