Provider Demographics
NPI:1780763656
Name:LOGUE, STEPHEN M (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:LOGUE
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 1:834 OPELIKA RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4022
Mailing Address - Country:US
Mailing Address - Phone:334-821-3012
Mailing Address - Fax:334-821-3314
Practice Address - Street 1:834 OPELIKA RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4022
Practice Address - Country:US
Practice Address - Phone:334-821-3012
Practice Address - Fax:334-821-3314
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU68867Medicare UPIN