Provider Demographics
NPI:1245451780
Name:STEVENS, JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:562 E CASTLE PINES PKWY
Mailing Address - Street 2:STE C-6B
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-4609
Mailing Address - Country:US
Mailing Address - Phone:303-814-8000
Mailing Address - Fax:303-660-2300
Practice Address - Street 1:562 E CASTLE PINES PKWY
Practice Address - Street 2:STE C-6B
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-4609
Practice Address - Country:US
Practice Address - Phone:303-814-8000
Practice Address - Fax:303-660-2300
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4569111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802224Medicare PIN
COU19432Medicare UPIN