Provider Demographics
NPI:1912055195
Name:SUM, STEPHEN V JR (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:V
Last Name:SUM
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:15520 ROCKFIELD BLVD A200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:20406 REDWOOD RD
Practice Address - Street 2:D
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4317
Practice Address - Country:US
Practice Address - Phone:510-538-1111
Practice Address - Fax:510-538-1040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2015-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA18971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0189710OtherPTAN
CADC18971OtherCHIROPRACTIC LICENSE
CADC0189710OtherBLUE SHIELD