MEDICARE: DR. STEPHEN JOHN CHITTENDEN 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	111N00000X	Chiropractor	2148	WA

General Provider Information

NPI Number	:	1487748372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JOHN CHITTENDEN D.C.

Provider Business Mailing Address
First Line	:	8905 GRAVELLY LAKE DR SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3109
Country	:	US
Telephone Number	:	253-581-1533
Fax Number	:	253-588-2145

Provider Business Practice Location Address
First Line	:	8905 GRAVELLY LAKE DR SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3109
Country	:	US
Telephone Number	:	253-581-1533
Fax Number	:	253-588-2145

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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