Provider Demographics
NPI:1841484698
Name:STEVENSON, AMANDA (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9620
Mailing Address - Country:US
Mailing Address - Phone:614-832-8862
Mailing Address - Fax:
Practice Address - Street 1:2511 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8956
Practice Address - Country:US
Practice Address - Phone:614-423-8745
Practice Address - Fax:614-423-2909
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3931111N00000X
OH3617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor