Provider Demographics
NPI:1104542885
Name:NIYONKURU, STEVEN JR
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:NIYONKURU
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 POLO PARK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-3267
Mailing Address - Country:US
Mailing Address - Phone:937-232-2265
Mailing Address - Fax:937-232-2265
Practice Address - Street 1:2206 POLO PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-3267
Practice Address - Country:US
Practice Address - Phone:937-232-2265
Practice Address - Fax:937-232-2265
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUQ924522111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9372191459OtherUNCLE