Provider Demographics
NPI:1215120688
Name:STEVENS CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:STEVENS CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-339-0220
Mailing Address - Street 1:1749 INDEPENDENCE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5903
Mailing Address - Country:US
Mailing Address - Phone:573-339-0220
Mailing Address - Fax:573-339-0418
Practice Address - Street 1:1749 INDEPENDENCE ST
Practice Address - Street 2:SUITE E
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5903
Practice Address - Country:US
Practice Address - Phone:573-339-0220
Practice Address - Fax:573-339-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy