Provider Demographics
NPI:1912948340
Name:ELY, STEPHEN LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LAWRENCE
Last Name:ELY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:L
Other - Last Name:ELY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10401 N 32ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3850
Mailing Address - Country:US
Mailing Address - Phone:602-996-8450
Mailing Address - Fax:602-996-8777
Practice Address - Street 1:10401 N 32ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3850
Practice Address - Country:US
Practice Address - Phone:602-996-8450
Practice Address - Fax:602-996-8777
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor