# MARK J STUBBENDIECK DC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609315571
- **Authorized official:** DR. MARK STUBBENDIECK DC (OWNER)
- **Authorized official phone:** (330) 725-4060

## Contact information

- **Practice address:** 780 E SMITH RD \# A, MEDINA, OH 44256-2662
- **Practice address phone:** (330) 725-4060
- **Practice address fax:** (330) 722-4582
- **Mailing address:** 780 E SMITH RD \# A, MEDINA, OH 44256-2662
- **Mailing address phone:** (133) 072-5406
- **Mailing address fax:** (330) 722-4582

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 1935 | OH | Yes |
| 111NR0400X | Rehabilitation Chiropractor | 1935 | OH | — |
| 111NS0005X | Sports Physician Chiropractor | 1935 | OH | — |

## Other

- **Enumeration date:** 02/13/2017
- **Last updated:** 09/21/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2657665 | — | OH |