Provider Demographics
NPI:1154338317
Name:EUSTICE, STEVEN BRADLEY (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRADLEY
Last Name:EUSTICE
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 1:721 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4044
Mailing Address - Country:US
Mailing Address - Phone:940-591-9097
Mailing Address - Fax:940-591-8483
Practice Address - Street 1:721 W HICKORY ST
Practice Address - Street 2:SUITE F
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4044
Practice Address - Country:US
Practice Address - Phone:940-591-9097
Practice Address - Fax:940-591-8483
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU55383Medicare UPIN
TX605178Medicare ID - Type UnspecifiedBCBS PROVIDER #