Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00423100 | NJ |
N | 111NS0005X | Chiropractic Sports Physician | DC-004734-L | PA |
NPI | 1205982832 |
---|---|
Provider Name | Edward Carl Stivers |
First Address | Edison, NJ 08817-4773 |
Second Address | Metuchen, NJ 08840-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |