Provider Demographics
NPI:1295848034
Name:COHEN, STEFAN B (DC)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:B
Last Name:COHEN
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 1:1541 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1056
Mailing Address - Country:US
Mailing Address - Phone:510-528-3028
Mailing Address - Fax:
Practice Address - Street 1:916 SAN PABLO AVE UNIT A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2059
Practice Address - Country:US
Practice Address - Phone:510-528-5216
Practice Address - Fax:510-528-5256
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0265430OtherBLUE SHIELD
CA0265430OtherBLUE SHIELD