MEDICARE: DR. STEPHEN ALEXANDER IRESTONE D.C., N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2115	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5C993IR	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1033285093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ALEXANDER IRESTONE D.C., N.D.

Provider Business Mailing Address
First Line	:	11970 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1516
Country	:	US
Telephone Number	:	952-895-7270
Fax Number	:	952-895-1086

Provider Business Practice Location Address
First Line	:	11970 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1516
Country	:	US
Telephone Number	:	952-895-7270
Fax Number	:	952-895-1086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	01/31/2012

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