Provider Demographics
NPI:1285750950
Name:EPPERSON, STUART SHANNON (DC)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:SHANNON
Last Name:EPPERSON
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 1:519 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1135
Mailing Address - Country:US
Mailing Address - Phone:614-314-4317
Mailing Address - Fax:740-364-1095
Practice Address - Street 1:974 N 21ST ST
Practice Address - Street 2:SUITE C2
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2990
Practice Address - Country:US
Practice Address - Phone:740-364-1060
Practice Address - Fax:740-364-1095
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2289116Medicaid