Provider Demographics
NPI:1689675977
Name:EDDY, STEVEN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:EDDY
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 1:443 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-1247
Mailing Address - Country:US
Mailing Address - Phone:304-375-6000
Mailing Address - Fax:304-375-6043
Practice Address - Street 1:443 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-1247
Practice Address - Country:US
Practice Address - Phone:304-375-6000
Practice Address - Fax:304-375-6043
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131911000Medicaid
5564005OtherAETNA
6617161OtherCIGNA
1840104OtherFIRST HEALTH NETWORK
389303OtherMAMSI
151727900OtherACS
550785922001OtherBC BS
OH0952938Medicaid
6617161OtherCIGNA
151727900OtherACS