Provider Demographics
NPI:1205968534
Name:STEVENS, JEREMIAH MICHAEL (ND)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:MICHAEL
Last Name:STEVENS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 N ARGONNE RD STE G
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2572
Mailing Address - Country:US
Mailing Address - Phone:509-590-1343
Mailing Address - Fax:866-774-8216
Practice Address - Street 1:1510 N ARGONNE RD STE G
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212
Practice Address - Country:US
Practice Address - Phone:509-590-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNAT-71175F00000X
WANT000001415175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANT00001415OtherSTATE LICENSE