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NPI Code Detail

MEDICARE: DR. JUSTIN STEVENSON DC

MEDICARE: DR. JUSTIN STEVENSON DC
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
1111N00000XChiropractor7126950-1202UT

General Provider Information

NPI Number : 1093188179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN STEVENSON DC
Provider Business Mailing Address
First Line : 6033 FASHION POINT DR
Second Line :
City : SOUTH OGDEN
State : UT
Zip : 84403-4847
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6033 FASHION POINT DR
Second Line :
City : SOUTH OGDEN
State : UT
Zip : 84403-4847
Country : US
Telephone Number : 801-475-6800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2015
Last Update Date : 11/11/2015

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Directions to “ DR. JUSTIN STEVENSON DC” Practice Location

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