Provider Demographics
NPI:1275671661
Name:STEPHENS, JOHN M (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:STEPHENS
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 1:8961 STATE ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241
Mailing Address - Country:US
Mailing Address - Phone:330-626-4300
Mailing Address - Fax:330-626-4919
Practice Address - Street 1:8961 STATE ROUTE 14
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241
Practice Address - Country:US
Practice Address - Phone:330-626-4300
Practice Address - Fax:330-626-4919
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157191Medicaid
U55785Medicare UPIN
OH0157191Medicaid