Provider Demographics
NPI:1083681894
Name:STEPHENS, DANIEL (ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 SHADOW XING
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-1495
Mailing Address - Country:US
Mailing Address - Phone:618-345-3854
Mailing Address - Fax:
Practice Address - Street 1:93 SHADOW XING
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-1495
Practice Address - Country:US
Practice Address - Phone:618-345-3854
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist