Provider Demographics
NPI:1801993191
Name:STEPHANO, JOSEPH MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:STEPHANO
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 1:845 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2943
Mailing Address - Country:US
Mailing Address - Phone:707-557-5000
Mailing Address - Fax:707-557-5291
Practice Address - Street 1:845 REDWOOD ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2943
Practice Address - Country:US
Practice Address - Phone:707-557-5000
Practice Address - Fax:707-557-5291
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25387111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78666Medicare UPIN