Provider Demographics
NPI:1972671188
Name:STEWART, A H III (DC)
Entity Type:Individual
Prefix:MR
First Name:A
Middle Name:H
Last Name:STEWART
Suffix:III
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 1:21 W FEE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-723-5015
Mailing Address - Fax:321-723-7389
Practice Address - Street 1:21 W FEE AVE
Practice Address - Street 2:STE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-723-5015
Practice Address - Fax:321-723-7389
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1034082OtherHIPPA COMP
CH0001519OtherLIC #
89493OtherBCBS
CH0001519OtherLIC #
1034082OtherHIPPA COMP