Provider Demographics
NPI:1215116033
Name:STEPHEN D. IVERSEN CHIROPRACTIC
Entity type:Organization
Organization Name:STEPHEN D. IVERSEN CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:IVERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-633-2225
Mailing Address - Street 1:2901 E KATELLA AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5248
Mailing Address - Country:US
Mailing Address - Phone:714-633-2225
Mailing Address - Fax:
Practice Address - Street 1:2901 E KATELLA AVE
Practice Address - Street 2:SUITE H
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5248
Practice Address - Country:US
Practice Address - Phone:714-633-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19846111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19018Medicare PIN
CAU10026Medicare UPIN