Provider Demographics
NPI:1215967559
Name:STEFANOU, BILL E (DC)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:E
Last Name:STEFANOU
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 1:111 CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9410
Mailing Address - Country:US
Mailing Address - Phone:856-983-8282
Mailing Address - Fax:856-596-7462
Practice Address - Street 1:111 CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9410
Practice Address - Country:US
Practice Address - Phone:856-983-8282
Practice Address - Fax:856-596-7462
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00228700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ43849OtherAETNA ID
NJSB263088OtherGHI INS.
NJ736820OtherUNITED HEALTHCARE
NJP413019OtherOXFORD HEALTHCARE
NJ22-2828991OtherTID
NJ610453800OtherUS DEPT OF LABOR / OWCP
NJ0101867000OtherAMERIHEALTH/KEYSTONE HMO
NJ736820OtherUNITED HEALTHCARE
NJ43849OtherAETNA ID