Provider Demographics
NPI:1063514743
Name:DOUDNA, STEPHEN STANLEY II (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:STANLEY
Last Name:DOUDNA
Suffix:II
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:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-0114
Mailing Address - Country:US
Mailing Address - Phone:740-732-4242
Mailing Address - Fax:740-732-9980
Practice Address - Street 1:400 NORTH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1217
Practice Address - Country:US
Practice Address - Phone:740-732-4242
Practice Address - Fax:740-732-9980
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0741219Medicaid
OHDO0630351Medicare PIN
OHT82004Medicare UPIN