MEDICARE: DR. GUS ALLEN STEVENS 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	2574	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336132240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUS ALLEN STEVENS D.C.

Provider Business Mailing Address
First Line	:	25730 BECKHAM SPRINGS CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-8458
Country	:	US
Telephone Number	:	281-355-0249
Fax Number	:	281-719-0359

Provider Business Practice Location Address
First Line	:	25730 BECKHAM SPRINGS CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-8458
Country	:	US
Telephone Number	:	281-355-0249
Fax Number	:	281-719-0359

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	10/02/2014

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