Provider Demographics
NPI:1003999632
Name:STEVENS, GAIL (DC)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 E JERICHO TPKE
Mailing Address - Street 2:STE 10
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2098
Mailing Address - Country:US
Mailing Address - Phone:516-294-1100
Mailing Address - Fax:516-294-2734
Practice Address - Street 1:166 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2097
Practice Address - Country:US
Practice Address - Phone:516-294-1100
Practice Address - Fax:516-294-2734
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0076691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGS0X034210Medicare PIN