Provider Demographics
NPI:1952623134
Name:AWWAD, STEPHEN VICTOR (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:VICTOR
Last Name:AWWAD
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 1:24100 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3155
Mailing Address - Country:US
Mailing Address - Phone:248-471-5554
Mailing Address - Fax:248-471-5008
Practice Address - Street 1:154 E HURON AVE
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1313
Practice Address - Country:US
Practice Address - Phone:989-269-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor