Provider Demographics
NPI:1457346595
Name:STEVENS, JODIE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:LYNN
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:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-0266
Mailing Address - Country:US
Mailing Address - Phone:734-241-4070
Mailing Address - Fax:734-241-0159
Practice Address - Street 1:11 E FRONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2228
Practice Address - Country:US
Practice Address - Phone:734-241-4070
Practice Address - Fax:734-241-0159
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP13920Medicare PIN
MIVO4482Medicare UPIN