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NPI Code Detail

MEDICARE: MATTHEW JONATHAN STEPHENS DC

MEDICARE: MATTHEW JONATHAN STEPHENS DC
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
1111N00000XChiropractor4647-012WI

General Provider Information

NPI Number : 1467768861
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JONATHAN STEPHENS DC
Provider Business Mailing Address
First Line : 909 S TAYLOR DR
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-4766
Country : US
Telephone Number : 920-451-7000
Fax Number :
Provider Business Practice Location Address
First Line : 909 S TAYLOR DR
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-4766
Country : US
Telephone Number : 920-451-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2010
Last Update Date : 12/04/2013

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