Provider Demographics
NPI:1760536056
Name:STEVENS, JOEL A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:A
Last Name:STEVENS
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:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0610
Mailing Address - Country:US
Mailing Address - Phone:920-459-9500
Mailing Address - Fax:920-459-9506
Practice Address - Street 1:1031 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4006
Practice Address - Country:US
Practice Address - Phone:920-459-9500
Practice Address - Fax:920-459-9506
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391876750012OtherBCBS
WI38864800Medicaid
WIU32079Medicare UPIN
WI000070382Medicare ID - Type Unspecified
WI391876750012OtherBCBS