Provider Demographics
NPI:1831125897
Name:STEVKO, ANNETTE M (DC CCSP)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:STEVKO
Suffix:
Gender:F
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 NE TILLAMOOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5342
Mailing Address - Country:US
Mailing Address - Phone:503-281-3400
Mailing Address - Fax:503-287-3787
Practice Address - Street 1:4111 NE TILLAMOOK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5342
Practice Address - Country:US
Practice Address - Phone:503-281-3400
Practice Address - Fax:503-287-3787
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR364880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
67467OtherKAISER
67467OtherKAISER
T68165Medicare UPIN