Provider Demographics
NPI:1386777324
Name:STASIO CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:STASIO CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STASIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-757-6285
Mailing Address - Street 1:26000 HOOVER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089
Mailing Address - Country:US
Mailing Address - Phone:586-757-6285
Mailing Address - Fax:586-757-6290
Practice Address - Street 1:26000 HOOVER RD
Practice Address - Street 2:SUITE 110 STASIO CHIROPRACTIC CENTER
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-757-6285
Practice Address - Fax:586-757-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63254Medicare UPIN
MI0M29960Medicare PIN