Provider Demographics
NPI:1366464687
Name:WARREN, STEPHEN NATHANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NATHANIEL
Last Name:WARREN
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 1:10203 E. 101ST ST. N.
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055
Mailing Address - Country:US
Mailing Address - Phone:918-640-0918
Mailing Address - Fax:918-272-1292
Practice Address - Street 1:8361 N OWASSO EXPY
Practice Address - Street 2:SUITE E
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2105
Practice Address - Country:US
Practice Address - Phone:918-640-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor