Provider Demographics
NPI:1104806132
Name:FIALA, STEVEN JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:FIALA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1502
Mailing Address - Country:US
Mailing Address - Phone:712-336-3304
Mailing Address - Fax:712-336-4619
Practice Address - Street 1:609 18TH ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1502
Practice Address - Country:US
Practice Address - Phone:712-336-3304
Practice Address - Fax:712-336-4619
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1015321Medicaid
IA56388OtherWELLMARK BCBS
IA15085OtherMIDLANDS CHOICE
IA18295Medicare ID - Type Unspecified
IAT92979Medicare UPIN