Provider Demographics
NPI:1679665756
Name:STEWART, JAMES KENNETH (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KENNETH
Last Name:STEWART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:173 S WILSON
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942
Mailing Address - Country:US
Mailing Address - Phone:979-542-8016
Mailing Address - Fax:979-542-8879
Practice Address - Street 1:173 S WILSON
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942
Practice Address - Country:US
Practice Address - Phone:979-542-8016
Practice Address - Fax:979-542-8879
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605825OtherBCBS
TX609063Medicare ID - Type Unspecified
TX605825OtherBCBS