Provider Demographics
NPI:1427154772
Name:STEVENS, BRIAN D (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:STEVENS
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 1:1749 E INDEPENDENCE SQ
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703
Mailing Address - Country:US
Mailing Address - Phone:573-339-0220
Mailing Address - Fax:573-339-0418
Practice Address - Street 1:1749 E INDEPENDENCE SQUARE
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:573-339-0220
Practice Address - Fax:573-339-0418
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1338OtherALLIANCE BCBS
MO178364OtherHEALTHLINK
MO1861145OtherFIRST HEALTH
MO5494OtherCMR
MO1861145OtherFIRST HEALTH