Provider Demographics
NPI:1194722330
Name:STENBERG, MARK ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:STENBERG
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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-0208
Mailing Address - Country:US
Mailing Address - Phone:218-732-7261
Mailing Address - Fax:218-732-7261
Practice Address - Street 1:708 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1215
Practice Address - Country:US
Practice Address - Phone:218-732-7261
Practice Address - Fax:218-732-7261
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C257STOtherBC/BS
U43139Medicare UPIN