Healthcare Provider Details

I. General information

NPI: 1306835970
Provider Name (Legal Business Name): STEVENS CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 E FLORIDA ST
DEMING NM
88030-5310
US

IV. Provider business mailing address

PO BOX 1518
DEMING NM
88031-1518
US

V. Phone/Fax

Practice location:
  • Phone: 505-546-2555
  • Fax: 505-546-2725
Mailing address:
  • Phone: 505-546-2555
  • Fax: 505-546-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1490
License Number StateNM

VIII. Authorized Official

Name: MR. JOEL B STEVENS
Title or Position: CHIROPRACTOR/MANAGING PARTNER
Credential: DC
Phone: 505-546-2555