Healthcare Provider Details

I. General information

NPI: 1164409900
Provider Name (Legal Business Name): STEPHEN HARKINS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CORPORATE DR SUITE 100
LADERA RANCH CA
92694-1152
US

IV. Provider business mailing address

800 CORPORATE DR STE. 100
LADERA RANCH CA
92694-1152
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-9112
  • Fax: 949-364-9016
Mailing address:
  • Phone: 949-364-9112
  • Fax: 949-364-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: