Healthcare Provider Details

I. General information

NPI: 1215116033
Provider Name (Legal Business Name): STEPHEN D. IVERSEN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 E KATELLA AVE SUITE H
ORANGE CA
92867-5248
US

IV. Provider business mailing address

2901 E KATELLA AVE SUITE H
ORANGE CA
92867-5248
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-2225
  • Fax:
Mailing address:
  • Phone: 714-633-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number19846
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN DALE IVERSEN
Title or Position: OWNER/ CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 714-633-2225