NPIMap

Organization Active NPI

Mark J Stubbendieck DC Inc

  • Chiropractor
  • Medina, OH
National Provider Identifier
1609315571
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1935 Issued in OH
Legal business name
MARK J STUBBENDIECK DC INC
Practice address
780 E Smith Rd # a
Medina, OH 44256-2662
Phone
(330) 725-4060
Fax
(330) 722-4582
NPI assigned
Feb 13, 2017
Last updated
Sep 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Stubbendieck, DCNPI 1841349834
Title
Owner
Phone
(330) 725-4060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 1935 OH Primary
Rehabilitation ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111NR0400X 1935 OH
Sports Physician ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111NS0005X 1935 OH

Addresses

Primary practice location

780 E Smith Rd # a
Medina, OH 44256-2662

Mailing address

780 E Smith Rd # a
Medina, OH 44256-2662
Phone (133) 072-5406

Other identifiers 1

IdentifierTypeStateIssuer
2657665MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Mark J Stubbendieck DC Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

257 S Court St
Ste 5A
Medina, OH 44256
Phone (330) 725-4060

780 E Smith Rd
#A
Medina, OH 44256
Phone (330) 725-4060

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1609315571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 E SMITH RD # A",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442562662",
            "telephone_number": "133-072-5406",
            "fax_number": "330-722-4582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 E SMITH RD # A",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442562662",
            "telephone_number": "330-725-4060",
            "fax_number": "330-722-4582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK J STUBBENDIECK DC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "STUBBENDIECK",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-725-4060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "1935",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "OH",
            "license": "1935",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "OH",
            "license": "1935",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2657665",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.