Provider Demographics
NPI:1093811150
Name:OWENS, STEVEN R (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:OWENS
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 1:3011 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8710
Mailing Address - Country:US
Mailing Address - Phone:715-234-6338
Mailing Address - Fax:
Practice Address - Street 1:3011 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8710
Practice Address - Country:US
Practice Address - Phone:715-234-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3379-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
45727OtherSECURITY HEALTH PLAN
WI38993700OtherMEDICAID GROUP
WI38898600Medicaid
WICB3715OtherRAILROAD MEDICARE GROUP
45727OtherSECURITY HEALTH PLAN
WI350041468Medicare PIN
45727OtherSECURITY HEALTH PLAN