Provider Demographics
NPI:1457427866
Name:STEVENS, BRENT R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:R
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WHITE SPAR RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4625
Mailing Address - Country:US
Mailing Address - Phone:928-776-4663
Mailing Address - Fax:928-776-4202
Practice Address - Street 1:405 WHITE SPAR RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4625
Practice Address - Country:US
Practice Address - Phone:928-776-4663
Practice Address - Fax:928-776-4202
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ74694Medicare ID - Type UnspecifiedMEDICARE ID #
AZU95183Medicare UPIN