Provider Demographics
NPI:1154398832
Name:DEMAINE, STEPHEN DAVID (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DAVID
Last Name:DEMAINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:DAVID
Other - Last Name:DEMAINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:504 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1421
Mailing Address - Country:US
Mailing Address - Phone:704-372-6960
Mailing Address - Fax:704-372-6890
Practice Address - Street 1:504 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1421
Practice Address - Country:US
Practice Address - Phone:704-372-6960
Practice Address - Fax:704-372-6890
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211535Medicaid
NC7211535Medicaid