Provider Demographics
NPI:1720176365
Name:WHEELER, STEPHEN M (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:WHEELER
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 1:2483 HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2831
Mailing Address - Country:US
Mailing Address - Phone:801-392-2612
Mailing Address - Fax:801-393-1377
Practice Address - Street 1:2483 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2831
Practice Address - Country:US
Practice Address - Phone:801-392-2612
Practice Address - Fax:801-393-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT152157-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870395551005Medicaid
UT870395551005Medicaid
UTT77996Medicare UPIN