Healthcare Provider Details

I. General information

NPI: 1790772028
Provider Name (Legal Business Name): PETER WILLIAM STEPHENS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 SW 32ND ST
OKEECHOBEE FL
34974-5919
US

IV. Provider business mailing address

375 SW 32ND ST
OKEECHOBEE FL
34974-5919
US

V. Phone/Fax

Practice location:
  • Phone: 863-763-0880
  • Fax: 863-763-3077
Mailing address:
  • Phone: 863-763-0880
  • Fax: 863-763-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0003189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: