Individual
DR. MARK J STUBBENDIECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
780 E SMITH RD UNIT A, MEDINA, OH 44256-2662
(330) 725-4060
(330) 722-4582
Mailing address
780 E SMITH RD # A, MEDINA, OH 44256-2662
(330) 725-4060
(330) 722-4582
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1935
OH
111NR0400X
Rehabilitation Chiropractor
1935
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000138771
ANTHEM BLUE CROSS
OH
05
—
2657665
—
OH
Enumeration date
01/09/2007
Last updated
09/21/2023
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