Provider Demographics
NPI:1912067570
Name:LANDIS, STEVE CLEVE (DC)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:CLEVE
Last Name:LANDIS
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 1:3621 FARQUHAR AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2005
Mailing Address - Country:US
Mailing Address - Phone:562-799-9969
Mailing Address - Fax:562-431-6522
Practice Address - Street 1:3621 FARQUHAR AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2005
Practice Address - Country:US
Practice Address - Phone:562-799-9969
Practice Address - Fax:562-431-6522
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 22748Medicare PIN