Provider Demographics
NPI:1578732269
Name:ROBERTA LYNNE STEVENS, D.C.
Entity Type:Organization
Organization Name:ROBERTA LYNNE STEVENS, D.C.
Other - Org Name:STEVENS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-801-4500
Mailing Address - Street 1:2600 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2807
Mailing Address - Country:US
Mailing Address - Phone:614-801-4500
Mailing Address - Fax:614-801-1343
Practice Address - Street 1:2600 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2807
Practice Address - Country:US
Practice Address - Phone:614-801-4500
Practice Address - Fax:614-801-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP02291Medicare PIN