Provider Demographics
NPI:1861450082
Name:COHEN, STEPHEN ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ERIC
Last Name:COHEN
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 1:1300 BAXTER ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3053
Mailing Address - Country:US
Mailing Address - Phone:704-333-5313
Mailing Address - Fax:704-333-7503
Practice Address - Street 1:1300 BAXTER ST
Practice Address - Street 2:SUITE 220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3053
Practice Address - Country:US
Practice Address - Phone:704-333-5313
Practice Address - Fax:704-333-7503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9992691OtherCIGNA HEALTHCARE PROVIDER
NC890831VMedicaid
NC615027OtherACN PROVIDER NO.
NC0831VOtherBCBS OF NC PROVIDER NO.
NC2451947Medicare ID - Type Unspecified
NC890831VMedicaid