Provider Demographics
NPI:1033285093
Name:IRESTONE, STEPHEN ALEXANDER (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALEXANDER
Last Name:IRESTONE
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11970 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1516
Mailing Address - Country:US
Mailing Address - Phone:952-895-7270
Mailing Address - Fax:952-895-1086
Practice Address - Street 1:11970 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1516
Practice Address - Country:US
Practice Address - Phone:952-895-7270
Practice Address - Fax:952-895-1086
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C993IROtherBCBS
MN350001787Medicare ID - Type Unspecified
MNT39300Medicare UPIN