Provider Demographics
NPI:1598788093
Name:SOMERVILLE, STEVEN PAUL (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:SOMERVILLE
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 1:903 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3193
Mailing Address - Country:US
Mailing Address - Phone:320-587-6666
Mailing Address - Fax:320-587-8244
Practice Address - Street 1:903 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3193
Practice Address - Country:US
Practice Address - Phone:320-587-6666
Practice Address - Fax:320-587-8244
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN607028100Medicaid
MN607028100Medicaid
MN350003285Medicare PIN