MEDICARE: ANGELINA VALERIE STEVENS D.C

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
1	111NN1001X	Nutrition Chiropractor	3162	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0194L	OTHER	NC	BC/BS

General Provider Information

NPI Number	:	1447272620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELINA VALERIE STEVENS D.C

Provider Business Mailing Address
First Line	:	1802 MARTIN LUTHER KING PKWY
Second Line	:	SUITE 107
City	:	DURHAM
State	:	NC
Zip	:	27707-3586
Country	:	US
Telephone Number	:	919-140-1506
Fax Number	:	919-401-8253

Provider Business Practice Location Address
First Line	:	1802 MARTIN LUTHER KING PKWY
Second Line	:	SUITE 107
City	:	DURHAM
State	:	NC
Zip	:	27707-3586
Country	:	US
Telephone Number	:	919-140-1506
Fax Number	:	919-401-8253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	09/06/2023

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Directions to “ ANGELINA VALERIE STEVENS D.C” Practice Location

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