Provider Demographics
NPI:1902815921
Name:CANUEL, STEPHEN HENRY (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HENRY
Last Name:CANUEL
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 1:1070 S WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1653
Mailing Address - Country:US
Mailing Address - Phone:321-499-4608
Mailing Address - Fax:321-499-4607
Practice Address - Street 1:1070 S WICKHAM RD
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1653
Practice Address - Country:US
Practice Address - Phone:321-499-4608
Practice Address - Fax:321-499-4607
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH8309OtherPROVIDER LISCENSE NUMBER
FL88004OtherBCBS PROVIDER NUMBER
FLU89087Medicare UPIN
FLU89087Medicare UPIN