Provider Demographics
NPI:1205982832
Name:STIVERS, EDWARD CARL (DC, CCSP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:CARL
Last Name:STIVERS
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4773
Mailing Address - Country:US
Mailing Address - Phone:732-248-0941
Mailing Address - Fax:
Practice Address - Street 1:276 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2453
Practice Address - Country:US
Practice Address - Phone:732-549-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00423100111NS0005X
PADC-004734-L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSTI127553Medicare ID - Type Unspecified