Healthcare Provider Details

I. General information

NPI: 1962649053
Provider Name (Legal Business Name): DE'ANDRA MICHELLE STEWART D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 CENTRAL PKWY SW STE G
DECATUR AL
35601-6850
US

IV. Provider business mailing address

1605 THOMAS DR SW
DECATUR AL
35601-2750
US

V. Phone/Fax

Practice location:
  • Phone: 256-777-6762
  • Fax: 256-649-2291
Mailing address:
  • Phone: 256-566-8619
  • Fax: 256-822-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2263
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2263
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: