Provider Demographics
NPI:1003945155
Name:STEPHENSON, CRAIG LOUIS (D C)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:LOUIS
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21518 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1804
Mailing Address - Country:US
Mailing Address - Phone:586-775-3778
Mailing Address - Fax:
Practice Address - Street 1:21518 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1804
Practice Address - Country:US
Practice Address - Phone:586-775-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2944111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F35373OtherBCBS
MIOE5001Medicare ID - Type Unspecified