Provider Demographics
NPI:1912119702
Name:STEVENS CHIROPRACTIC
Entity Type:Organization
Organization Name:STEVENS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-395-2225
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2623
Mailing Address - Country:US
Mailing Address - Phone:618-395-2225
Mailing Address - Fax:618-395-7044
Practice Address - Street 1:600 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2623
Practice Address - Country:US
Practice Address - Phone:618-395-2225
Practice Address - Fax:618-395-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08022501OtherBCBS #
IL08022501OtherBCBS #
ILU72692Medicare UPIN