Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1106 | ID |
N | 111N00000X | Chiropractor | 289810-1202 | UT |
NPI | 1013027952 |
---|---|
Provider Name | Dr. Matthew Brinton Stevens |
First Address | Montpelier, ID 83254-0026 |
Second Address | Montpelier, ID 83254-1050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010155708 | REGENCY BLUE SHIELD (01) | ID |
5638605 | FIRST HEALTH (01) | ID |
C4959 | BLUE CROSS PROVIDER NUMBE (01) | ID |
P00271311 | RR MEDICARE (01) | ID |