Provider Demographics
NPI:1982911582
Name:C. STEPHENS COMPANIES, LLC
Entity Type:Organization
Organization Name:C. STEPHENS COMPANIES, LLC
Other - Org Name:DAYTONA BEACH SHORES CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:FRANCESCO
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-847-2263
Mailing Address - Street 1:6535 SHAHAB LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6075
Mailing Address - Country:US
Mailing Address - Phone:386-847-2263
Mailing Address - Fax:386-756-9855
Practice Address - Street 1:116 DUNLAWTON BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-2607
Practice Address - Country:US
Practice Address - Phone:386-756-9484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002381300Medicaid