Provider Demographics
NPI:1013935345
Name:STEVENS, LINDA D (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:D
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12951 METRO PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1333
Mailing Address - Country:US
Mailing Address - Phone:239-489-4100
Mailing Address - Fax:239-489-1314
Practice Address - Street 1:12951 METRO PKWY STE 5
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1333
Practice Address - Country:US
Practice Address - Phone:239-489-4100
Practice Address - Fax:239-489-1314
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53890Medicare ID - Type Unspecified