Provider Demographics
NPI:1992761084
Name:STEVENS, GERALD LESTER (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LESTER
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 1:4974 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4616
Mailing Address - Country:US
Mailing Address - Phone:716-685-9631
Mailing Address - Fax:716-685-9750
Practice Address - Street 1:4974 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4616
Practice Address - Country:US
Practice Address - Phone:716-685-9631
Practice Address - Fax:716-685-9750
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY652546OtherAMERICAN CHIROPRACTIC NET
NY73-1664708OtherLANDMARK
NY8811391OtherINDEPENDENT HEALTH
NYC10352-5BOtherWORKERS COMPENSATION
NY837319OtherMANAGED PHYSOCAL NETWORK
NY7514542OtherAETNA
NY73-1664708OtherLANDMARK
NY837319OtherMANAGED PHYSOCAL NETWORK