Provider Demographics
NPI:1306835970
Name:STEVENS CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:STEVENS CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-546-2555
Mailing Address - Street 1:PO BOX 1518
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88031-1518
Mailing Address - Country:US
Mailing Address - Phone:505-546-2555
Mailing Address - Fax:505-546-2725
Practice Address - Street 1:722 E FLORIDA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5310
Practice Address - Country:US
Practice Address - Phone:505-546-2555
Practice Address - Fax:505-546-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01KH64OtherBCBS
31806OtherLOVELACE
63180OtherPRES
DA432ZOtherRR MEDICARE
U81011Medicare UPIN