Provider Demographics
NPI:1619141504
Name:KEPICS, STEPHEN MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:KEPICS
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 1:1861 CHALCEDONY ST
Mailing Address - Street 2:APT. A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3215
Mailing Address - Country:US
Mailing Address - Phone:619-999-6612
Mailing Address - Fax:
Practice Address - Street 1:1861 CHALCEDONY ST
Practice Address - Street 2:APT. A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3215
Practice Address - Country:US
Practice Address - Phone:619-999-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor