Provider Demographics
NPI:1891256541
Name:STIVER, ANNIE ROSE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:ROSE
Last Name:STIVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S PITNEY RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9774
Mailing Address - Country:US
Mailing Address - Phone:609-204-7419
Mailing Address - Fax:
Practice Address - Street 1:821 CLIFF ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2097
Practice Address - Country:US
Practice Address - Phone:607-256-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor