Provider Demographics
NPI:1497029771
Name:ANNETTE STEVKO
Entity Type:Organization
Organization Name:ANNETTE STEVKO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC,CCSP
Authorized Official - Phone:503-281-3400
Mailing Address - Street 1:4111 NE TILLAMOOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5342
Mailing Address - Country:US
Mailing Address - Phone:503-281-3400
Mailing Address - Fax:
Practice Address - Street 1:4111 NE TILLAMOOK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5342
Practice Address - Country:US
Practice Address - Phone:503-281-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1831125897OtherNPI 1
OR0000QGCVHMedicare PIN
OR1831125897OtherNPI 1