Provider Demographics
NPI:1770690182
Name:STEPHENS III, WESTERON (DC)
Entity Type:Individual
Prefix:
First Name:WESTERON
Middle Name:
Last Name:STEPHENS III
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 1:2001 LARKIN AVE
Mailing Address - Street 2:SUITE 007
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5808
Mailing Address - Country:US
Mailing Address - Phone:847-742-4200
Mailing Address - Fax:847-841-1716
Practice Address - Street 1:2001 LARKIN AVE
Practice Address - Street 2:SUITE 007
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5808
Practice Address - Country:US
Practice Address - Phone:847-742-4200
Practice Address - Fax:847-841-1716
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2283011OtherBCBS
IL2283011OtherBCBS
T37350Medicare UPIN