Provider Demographics
NPI:1053459628
Name:PRICE, STEPHEN L (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:PRICE
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 1:3128 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2665
Mailing Address - Country:US
Mailing Address - Phone:812-232-3718
Mailing Address - Fax:812-232-7247
Practice Address - Street 1:3128 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2665
Practice Address - Country:US
Practice Address - Phone:812-232-3718
Practice Address - Fax:812-232-7247
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000621A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084992Medicare UPIN
IN855400Medicare ID - Type UnspecifiedCHIROPRACTOR