Provider Demographics
NPI:1407055627
Name:MAGALLANES, STEVEN JOSEPH JR (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:MAGALLANES
Suffix:JR
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 1:524 S CLOVIS AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4529
Mailing Address - Country:US
Mailing Address - Phone:559-456-0263
Mailing Address - Fax:888-214-8287
Practice Address - Street 1:524 S CLOVIS AVE
Practice Address - Street 2:SUITE J
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4529
Practice Address - Country:US
Practice Address - Phone:559-456-0263
Practice Address - Fax:888-214-8287
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0250800Medicare UPIN