Provider Demographics
NPI:1912054933
Name:STEWARD, BRIC A (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIC
Middle Name:A
Last Name:STEWARD
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 1:908 S. COMMERCIAL STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946
Mailing Address - Country:US
Mailing Address - Phone:618-252-2225
Mailing Address - Fax:618-252-0512
Practice Address - Street 1:908 S. COMMERCIAL STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946
Practice Address - Country:US
Practice Address - Phone:618-252-2225
Practice Address - Fax:618-252-0512
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03532001OtherBLUE CROSS BLUE
IL038-010068Medicaid
IL038010068OtherLICENSE #