Provider Demographics
NPI:1669523296
Name:STEFOS, ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:STEFOS
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 1:122 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 ELM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1902
Practice Address - Country:US
Practice Address - Phone:508-754-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015465OtherNEIGHBORHOOD HEALTH PLAN
729156OtherTUFTS
MA98781501OtherNETWORK HEALTH
352329OtherHARVARD PILGRIM
606340OtherUNITED HEALTH CARE
MA1608738Medicaid
736196OtherAETNA
MAY40007OtherBLUE CROSS
1033227OtherASHN
237920OtherCIGNA
MA0015465OtherNEIGHBORHOOD HEALTH PLAN
T58449Medicare UPIN