MEDICARE: STEPHEN D. IVERSEN CHIROPRACTIC

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	111NR0400X	Rehabilitation Chiropractor	19846	CA

General Provider Information

NPI Number	:	1215116033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN D. IVERSEN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2901 E KATELLA AVE
Second Line	:	SUITE H
City	:	ORANGE
State	:	CA
Zip	:	92867-5248
Country	:	US
Telephone Number	:	714-633-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 E KATELLA AVE
Second Line	:	SUITE H
City	:	ORANGE
State	:	CA
Zip	:	92867-5248
Country	:	US
Telephone Number	:	714-633-2225
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ CHIROPRACTIC PHYSICIAN
Name	:	DR. STEPHEN DALE IVERSEN
Credential	:	D.C.
Telephone Number	:	714-633-2225

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	06/02/2016

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