Healthcare Provider Details

I. General information

NPI: 1619197209
Provider Name (Legal Business Name): STEPHEN A STEPANIUK DC, QME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14623 HAWTHORNE BLVD #406
LAWNDALE CA
90260
US

IV. Provider business mailing address

3855 MOTOR AVE SUITE 103
CULVER CITY CA
90232-3196
US

V. Phone/Fax

Practice location:
  • Phone: 877-204-5682
  • Fax: 310-356-7910
Mailing address:
  • Phone: 310-841-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28023
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC28023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: