Provider Demographics
NPI:1285642868
Name:BLEVINS, STEVEN W (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:BLEVINS
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 1:116 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1524
Mailing Address - Country:US
Mailing Address - Phone:847-639-8996
Mailing Address - Fax:
Practice Address - Street 1:116 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1524
Practice Address - Country:US
Practice Address - Phone:847-899-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T35037Medicare UPIN
IL287852Medicare ID - Type Unspecified