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NPI Code Detail

MEDICARE: DR. NATHAN A STEVENS

MEDICARE: DR. NATHAN A STEVENS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NS0005XSports Physician Chiropractor038-008490IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3350044665OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
108022501OTHERILBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114035896
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHAN A STEVENS
Provider Business Mailing Address
First Line : PO BOX 247
Second Line :
City : OLNEY
State : IL
Zip : 62450-0247
Country : US
Telephone Number : 618-395-2225
Fax Number :
Provider Business Practice Location Address
First Line : 600 WEST MAIN
Second Line :
City : OLNEY
State : IL
Zip : 62450-2623
Country : US
Telephone Number : 618-395-2225
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/16/2012

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Directions to “ DR. NATHAN A STEVENS ” Practice Location

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