MEDICARE: ANNETTE STEVKO

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	1792	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1831125897	OTHER	OR	NPI 1

General Provider Information

NPI Number	:	1497029771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNETTE STEVKO

Provider Business Mailing Address
First Line	:	4111 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5342
Country	:	US
Telephone Number	:	503-281-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4111 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5342
Country	:	US
Telephone Number	:	503-281-3400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANNETTE STEVKO
Credential	:	DC,CCSP
Telephone Number	:	503-281-3400

Provider Enumeration Date	:	03/03/2012
Last Update Date	:	03/03/2012

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Directions to “ANNETTE STEVKO ” Practice Location

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