MEDICARE: JOSHUA ALEXIS 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	111NN1001X	Nutrition Chiropractor	3049	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0194L	OTHER	NC	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1588686760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA ALEXIS STEVENS D.C.

Provider Business Mailing Address
First Line	:	1802 MARTIN LUTHER KING PKWY
Second Line	:	SUITE 107
City	:	DURHAM
State	:	NC
Zip	:	27707-3586
Country	:	US
Telephone Number	:	919-401-5061
Fax Number	:	919-401-5061

Provider Business Practice Location Address
First Line	:	1802 MARTIN LUTHER KING PKWY
Second Line	:	SUITE 107
City	:	DURHAM
State	:	NC
Zip	:	27707-3586
Country	:	US
Telephone Number	:	919-401-5061
Fax Number	:	919-401-5061

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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