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General NPI Number Information
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NPI Number | 1104013630
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Entity Type | Organization
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Legal Business Name | STEWART CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 01/29/2011
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Provider Practice Location Address
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Address Line | 205 SILVER BLUFF RD
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City | AIKEN
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State | SC
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Zip | 29803-7325
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Country | US
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Telephone | 803-648-0189
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Fax |
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Provider Business Mailing Address
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Address Line | 205 SILVER BLUFF RD
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City | AIKEN
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State | SC
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Zip | 29803-7325
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Country | US
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Telephone | 803-648-0189
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANE D STEWART
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Credential | DC
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Telephone | 803-648-0189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | SC812
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License Number State | SC
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