Provider Demographics
NPI:1497776884
Name:HALVERSON, STEPHEN DOUGLAS (LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:HALVERSON
Suffix:
Gender:M
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FINLEY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8624
Mailing Address - Country:US
Mailing Address - Phone:919-622-5934
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NORTH CAROLINA - CHAPEL HILL
Practice Address - Street 2:JAMES A. TAYLOR CAMPUS HEALTH SERVICES, CB #7470
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599
Practice Address - Country:US
Practice Address - Phone:919-966-6548
Practice Address - Fax:919-966-9779
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer