MEDICARE: STEVENS CHIROPRACTIC PC

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	329761-1202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881975951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENS CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	1635 N 200 E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1913
Country	:	US
Telephone Number	:	435-755-7654
Fax Number	:	435-753-7654

Provider Business Practice Location Address
First Line	:	1635 N 200 E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1913
Country	:	US
Telephone Number	:	435-755-7654
Fax Number	:	435-753-7654

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DEE STEVENS
Credential	:	DC
Telephone Number	:	435-755-7654

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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Directions to “STEVENS CHIROPRACTIC PC ” Practice Location

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