Provider Demographics
NPI:1003939273
Name:STEWART, DARREN L (DC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:L
Last Name:STEWART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5343 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4252
Mailing Address - Country:US
Mailing Address - Phone:909-305-0714
Mailing Address - Fax:909-394-7415
Practice Address - Street 1:5343 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4252
Practice Address - Country:US
Practice Address - Phone:909-305-0714
Practice Address - Fax:909-394-7415
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258100Medicaid
CADC0258100Medicaid