Provider Demographics
NPI:1770733297
Name:STEPHENS, LEIF ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:LEIF
Middle Name:ALLEN
Last Name:STEPHENS
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 1:329 E PLATTE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701
Mailing Address - Country:US
Mailing Address - Phone:970-458-5216
Mailing Address - Fax:720-247-9072
Practice Address - Street 1:329 E PLATTE AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3172
Practice Address - Country:US
Practice Address - Phone:970-458-5216
Practice Address - Fax:720-247-9072
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCR-6282111N00000X
COCHR6282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO40732Medicare UPIN