Healthcare Provider Details

I. General information

NPI: 1679665756
Provider Name (Legal Business Name): JAMES KENNETH STEWART DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIMMY STEWART DC

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 S WILSON
GIDDINGS TX
78942
US

IV. Provider business mailing address

173 S WILSON
GIDDINGS TX
78942
US

V. Phone/Fax

Practice location:
  • Phone: 979-542-8016
  • Fax: 979-542-8879
Mailing address:
  • Phone: 979-542-8016
  • Fax: 979-542-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: