Provider Demographics
NPI:1710322540
Name:STEPHENS CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:STEPHENS CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-234-9876
Mailing Address - Street 1:2021 CENEX DR
Mailing Address - Street 2:STE E
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1891
Mailing Address - Country:US
Mailing Address - Phone:715-234-9876
Mailing Address - Fax:715-234-0855
Practice Address - Street 1:2021 CENEX DR
Practice Address - Street 2:STE E
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1891
Practice Address - Country:US
Practice Address - Phone:715-234-9876
Practice Address - Fax:715-234-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty