Provider Demographics
NPI:1831214899
Name:NOTHNAGLE, STEPHEN M (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:NOTHNAGLE
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 1:4889 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-1311
Mailing Address - Country:US
Mailing Address - Phone:585-323-2046
Mailing Address - Fax:
Practice Address - Street 1:3800 RAILROAD AVE.
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-0162
Practice Address - Country:US
Practice Address - Phone:315-589-9221
Practice Address - Fax:315-589-5007
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor