Provider Demographics
NPI:1285174151
Name:ROBERT L. STEVENS D.C. INC.
Entity type:Organization
Organization Name:ROBERT L. STEVENS D.C. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-200-6494
Mailing Address - Street 1:28803 DAHLIA DR NW
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-6331
Mailing Address - Country:US
Mailing Address - Phone:630-200-6494
Mailing Address - Fax:
Practice Address - Street 1:109 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1213
Practice Address - Country:US
Practice Address - Phone:740-942-2290
Practice Address - Fax:740-942-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
OH565261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH026383Medicaid
OH565OtherHEALTH PLAN PROVIDER #
OH0040084Medicaid
OH565OtherHEALTH PLAN PROVIDER #
OH0384331Medicare PIN