Provider Demographics
NPI:1790826832
Name:STEWART FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:STEWART FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-288-0280
Mailing Address - Street 1:1 NOVAK DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-3753
Mailing Address - Country:US
Mailing Address - Phone:540-288-0280
Mailing Address - Fax:540-288-3313
Practice Address - Street 1:1 NOVAK DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3753
Practice Address - Country:US
Practice Address - Phone:540-288-0280
Practice Address - Fax:540-288-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06693Medicare ID - Type UnspecifiedGROUP MEDICARE ID