Provider Demographics
NPI:1154496701
Name:VERBOVANEC, STEPHEN GARY (DC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GARY
Last Name:VERBOVANEC
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:WATKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55389
Mailing Address - Country:US
Mailing Address - Phone:320-764-3000
Mailing Address - Fax:320-764-3000
Practice Address - Street 1:165 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WATKINS
Practice Address - State:MN
Practice Address - Zip Code:55389
Practice Address - Country:US
Practice Address - Phone:320-764-3000
Practice Address - Fax:320-764-3000
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-08-06
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-06
Provider Licenses
StateLicense IDTaxonomies
MN2458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN356K6WAOtherBLUE CROSS BLUE SHIELD
MNT66253Medicare UPIN