Provider Demographics
NPI:1881742997
Name:STERN, IAN SCOTT (DC, CCN, CSCS)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:SCOTT
Last Name:STERN
Suffix:
Gender:M
Credentials:DC, CCN, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 91ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5854
Mailing Address - Country:US
Mailing Address - Phone:718-680-6156
Mailing Address - Fax:
Practice Address - Street 1:346 91ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5854
Practice Address - Country:US
Practice Address - Phone:718-680-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008519-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5804507OtherGHI
NYX86882OtherEMPIRE BCBS
NYP559457OtherOXFORD
NYX86881Medicare ID - Type Unspecified
NYX86882OtherEMPIRE BCBS