Basic Information
Provider Information
NPI: 1033473798
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEGNER
FirstName: JAMES
MiddleName: RICH
NamePrefix: DR.
NameSuffix: JR.
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 165 N ARLINGTON HEIGHTS RD
Address2: STE 170
City: BUFFALO GROVE
State: IL
PostalCode: 600891783
CountryCode: US
TelephoneNumber: 2246760463
FaxNumber:  
Practice Location
Address1: 165 N ARLINGTON HEIGHTS RD
Address2: STE 170
City: BUFFALO GROVE
State: IL
PostalCode: 600891783
CountryCode: US
TelephoneNumber: 2246760463
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/27/2012
LastUpdateDate: 06/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X038012208ILY Chiropractic ProvidersChiropractor 

No ID Information.


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