MEDICARE: DR. RODEN C STEWART D.C.

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	CH9501	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22492	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1164607602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODEN C STEWART D.C.

Provider Business Mailing Address
First Line	:	6295 TEAL LN
Second Line	:
City	:	CHINCOTEAGUE ISLAND
State	:	VA
Zip	:	23336-2207
Country	:	US
Telephone Number	:	757-336-7170
Fax Number	:	321-800-3383

Provider Business Practice Location Address
First Line	:	6295 TEAL LN
Second Line	:
City	:	CHINCOTEAGUE ISLAND
State	:	VA
Zip	:	23336-2207
Country	:	US
Telephone Number	:	757-336-7170
Fax Number	:	321-800-3383

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

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	02/16/2023

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