Provider Demographics
NPI:1710022702
Name:STEPHAN, JOSEPH EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EUGENE
Last Name:STEPHAN
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 1:42 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3611
Mailing Address - Country:US
Mailing Address - Phone:516-652-7336
Mailing Address - Fax:516-586-5101
Practice Address - Street 1:42 RICHARD ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3611
Practice Address - Country:US
Practice Address - Phone:516-652-7336
Practice Address - Fax:516-586-5101
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008397-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor