Provider Demographics
NPI:1043942717
Name:STEPHENS, THOMAS CALVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CALVIN
Last Name:STEPHENS
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 1:3416 PINEY GROVE WILBON RD
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-8125
Mailing Address - Country:US
Mailing Address - Phone:919-510-1186
Mailing Address - Fax:
Practice Address - Street 1:3416 PINEY GROVE WILBON RD
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-8125
Practice Address - Country:US
Practice Address - Phone:919-510-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty