MEDICARE: ANNETTE M STEVKO DC CCSP

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	364880	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	67467	OTHER		KAISER

General Provider Information

NPI Number	:	1831125897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE M STEVKO DC CCSP

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	:	503-287-3787

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	:	503-287-3787

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	05/07/2008

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