Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 4569 | CO |
NPI | 1245451780 |
---|---|
Provider Name | Dr. John Stevens |
First Address | Castle Rock, CO 80108-4609 |
Second Address | Castle Rock, CO 80108-4609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 26/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U19432 | (02) | CO |