Provider Demographics
NPI:1700943230
Name:STEVENS, BARTHOLOMEW GIBBS (DC)
Entity type:Individual
Prefix:DR
First Name:BARTHOLOMEW
Middle Name:GIBBS
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 1:1001 WILSHIRE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5716
Mailing Address - Country:US
Mailing Address - Phone:817-447-1414
Mailing Address - Fax:817-447-3463
Practice Address - Street 1:1001 WILSHIRE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5716
Practice Address - Country:US
Practice Address - Phone:817-447-1414
Practice Address - Fax:817-447-3463
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 5301 DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7231OtherBLUE CROSS BLUE SHIELD
TXT89758Medicare UPIN
TX8A7231OtherBLUE CROSS BLUE SHIELD