Provider Demographics
NPI:1235158494
Name:STEVENS CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:STEVENS CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:THE CHIROPRACTIC CONNECTION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:STEVEND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-401-5061
Mailing Address - Street 1:1802 MARTIN LUTHER KING PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3586
Mailing Address - Country:US
Mailing Address - Phone:919-401-5061
Mailing Address - Fax:919-401-8253
Practice Address - Street 1:1802 MARTIN LUTHER KING PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3586
Practice Address - Country:US
Practice Address - Phone:919-401-5061
Practice Address - Fax:919-401-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3049111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014H9OtherBLUE CROSS/BLUE SHIELD