1477649051 NPI number — DR. AMBER LYNN STENZEL DC

Table of content: DR. AMBER LYNN STENZEL DC (NPI 1477649051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477649051 NPI number — DR. AMBER LYNN STENZEL DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STENZEL
Provider First Name:
AMBER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIEBELING
Provider Other First Name:
AMBER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477649051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 S MARKET
Provider Second Line Business Mailing Address:
PO BOX 196
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-939-3411
Provider Business Mailing Address Fax Number:
618-939-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 S MARKET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-939-3411
Provider Business Practice Location Address Fax Number:
618-939-3411
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 06732005 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 511483 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00405007 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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