Provider Demographics
NPI:1336132240
Name:STEVENS, GUS ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GUS
Middle Name:ALLEN
Last Name:STEVENS
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 1:25730 BECKHAM SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8458
Mailing Address - Country:US
Mailing Address - Phone:281-355-0249
Mailing Address - Fax:281-719-0359
Practice Address - Street 1:25730 BECKHAM SPRINGS CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-8458
Practice Address - Country:US
Practice Address - Phone:281-355-0249
Practice Address - Fax:281-719-0359
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001079501Medicaid
TX001079501Medicaid
TXT16115Medicare UPIN