Provider Demographics
NPI:1760415954
Name:STEPHENS, JOSHUA C (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:C
Last Name:STEPHENS
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 1:741 KRISTINE CT
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-8259
Mailing Address - Country:US
Mailing Address - Phone:912-968-5778
Mailing Address - Fax:
Practice Address - Street 1:4735 DAHLGREN RD STE 100
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MN
Practice Address - Zip Code:55315-4420
Practice Address - Country:US
Practice Address - Phone:952-594-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor