Provider Demographics
NPI:1356481386
Name:STEPHENS, SHAWN A (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:A
Last Name:STEPHENS
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:STEPHENS CHIROPRACTIC CENTER
Mailing Address - Street 2:935 SW BAYA DR
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056
Mailing Address - Country:US
Mailing Address - Phone:386-755-4310
Mailing Address - Fax:386-755-6912
Practice Address - Street 1:935 SW BAYA DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4210
Practice Address - Country:US
Practice Address - Phone:386-755-4310
Practice Address - Fax:386-755-6912
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22717OtherBLUE CROSS BLUE SHIELD
FL22717Medicare ID - Type UnspecifiedCHIROPRACTIC
FLU26120Medicare UPIN