Provider Demographics
NPI:1346458148
Name:STEWART, BEVERLY (DC)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 UNO LAGO DR
Mailing Address - Street 2:
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2661
Mailing Address - Country:US
Mailing Address - Phone:732-406-1130
Mailing Address - Fax:732-548-6688
Practice Address - Street 1:15 REMINGTON DR
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3626
Practice Address - Country:US
Practice Address - Phone:732-406-1130
Practice Address - Fax:732-548-6688
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO3669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU25935Medicare UPIN