Provider Demographics
NPI:1073577003
Name:STEPANOVICH, DENNIS CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:CHARLES
Last Name:STEPANOVICH
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 1:3303 W SAGINAW ST
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2303
Mailing Address - Country:US
Mailing Address - Phone:517-323-2500
Mailing Address - Fax:517-323-3161
Practice Address - Street 1:3303 W SAGINAW ST
Practice Address - Street 2:SUITE A-2
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2303
Practice Address - Country:US
Practice Address - Phone:517-323-2500
Practice Address - Fax:517-323-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C313530OtherBLUU CROSS BLUE SHIELD
MIU26767Medicare UPIN
MI0C35026Medicare ID - Type Unspecified