Provider Demographics
NPI:1588761050
Name:STAMBAUGH, DANIEL PATRICK (DC, CCSP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:STAMBAUGH
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2919
Mailing Address - Country:US
Mailing Address - Phone:740-366-6601
Mailing Address - Fax:740-366-6286
Practice Address - Street 1:919 N 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2919
Practice Address - Country:US
Practice Address - Phone:740-366-6601
Practice Address - Fax:740-366-6286
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2391111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2069023Medicaid
OH2069023Medicaid
OH4234801Medicare PIN