Provider Demographics
NPI:1710145032
Name:UNVERZAGT, STEPHEN CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHRISTOPHER
Last Name:UNVERZAGT
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 1:1329 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2546
Mailing Address - Country:US
Mailing Address - Phone:217-544-3628
Mailing Address - Fax:217-544-3627
Practice Address - Street 1:1329 S 4TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2546
Practice Address - Country:US
Practice Address - Phone:217-544-3628
Practice Address - Fax:217-544-3627
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor