Provider Demographics
NPI:1013027952
Name:STEVENS, MATTHEW BRINTON (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRINTON
Last Name:STEVENS
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-0026
Mailing Address - Country:US
Mailing Address - Phone:208-847-2273
Mailing Address - Fax:208-847-0678
Practice Address - Street 1:710 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-1050
Practice Address - Country:US
Practice Address - Phone:208-847-2273
Practice Address - Fax:208-847-0678
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1106111N00000X
UT289810-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010155708OtherREGENCY BLUE SHIELD
ID5638605OtherFIRST HEALTH
IDP00271311OtherRR MEDICARE
IDC4959OtherBLUE CROSS PROVIDER NUMBE
IDP00271311OtherRR MEDICARE