Provider Demographics
NPI:1912014762
Name:STEWART, DENNISE LISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNISE
Middle Name:LISSA
Last Name:STEWART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DENNISE
Other - Middle Name:LISSA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1600 SOUTH EADS STREET
Mailing Address - Street 2:APT 131N
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202
Mailing Address - Country:US
Mailing Address - Phone:703-920-0693
Mailing Address - Fax:
Practice Address - Street 1:4115 ANNANDALE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-642-8722
Practice Address - Fax:703-642-8756
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor