Provider Demographics
NPI:1356642953
Name:STEWART, NATHAN ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ADAM
Last Name:STEWART
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 1:835 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4476
Mailing Address - Country:US
Mailing Address - Phone:815-517-0917
Mailing Address - Fax:
Practice Address - Street 1:835 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4476
Practice Address - Country:US
Practice Address - Phone:815-517-0917
Practice Address - Fax:815-517-0927
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor