Provider Demographics
NPI:1194986984
Name:STEPHENSON, SCOTT C
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:STEPHENSON
Suffix:
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 1:1665 OAK PARK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CALVERT CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42029
Mailing Address - Country:US
Mailing Address - Phone:270-395-9734
Mailing Address - Fax:270-395-0203
Practice Address - Street 1:1665 OAK PARK BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:CALVERT CITY
Practice Address - State:KY
Practice Address - Zip Code:42029
Practice Address - Country:US
Practice Address - Phone:270-395-9734
Practice Address - Fax:270-395-0203
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011197111N00000X
KY5273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor