Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4558 | OH |
NPI | 1003276981 |
---|---|
Provider Name | Dr. Brett Christopher Stefan |
First Address | Columbus, OH 43231-4063 |
Second Address | Columbus, OH 43231-4063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2016 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4558 | CHIROPRACTIC LICENSE (01) | OH |