Provider Demographics
NPI:1528161460
Name:STEVENS, JOHN WILLIAMS (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAMS
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:PO BOX 447
Mailing Address - Street 2:RT. 6 & 11 NORTHERN BLVD.
Mailing Address - City:CHINCHILLA
Mailing Address - State:PA
Mailing Address - Zip Code:18410-0447
Mailing Address - Country:US
Mailing Address - Phone:570-586-0707
Mailing Address - Fax:570-587-5979
Practice Address - Street 1:330 NORTHERN BOULEVARD
Practice Address - Street 2:SUITE 447
Practice Address - City:CHINCHILLA
Practice Address - State:PA
Practice Address - Zip Code:18410
Practice Address - Country:US
Practice Address - Phone:570-586-0707
Practice Address - Fax:570-587-5979
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ-005225-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA479811OtherBLUE SHIELD
PA804331OtherFIRST PRIORITY
PA804331OtherFIRST PRIORITY