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General NPI Number Information
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NPI Number | 1104008572
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Entity Type | Organization
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Legal Business Name | STEPHENS PAIN RECOVERY CENTER, INC.
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 8961 STATE ROUTE 14
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City | STREETSBORO
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State | OH
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Zip | 44241-5625
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Country | US
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Telephone | 330-626-4300
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Fax | 330-626-4919
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Provider Business Mailing Address
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Address Line | 8961 STATE ROUTE 14
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City | STREETSBORO
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State | OH
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Zip | 44241-5625
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Country | US
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Telephone | 330-626-4300
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Fax | 330-626-4919
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN M STEPHENS
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Credential | D.C.
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Telephone | 330-626-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2156
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License Number State | OH
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