Provider Demographics
NPI:1902962434
Name:ISADORE, STEVEN G (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:ISADORE
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 1:107 HALSMER CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8524
Mailing Address - Country:US
Mailing Address - Phone:919-233-4848
Mailing Address - Fax:
Practice Address - Street 1:1151 SE CARY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7418
Practice Address - Country:US
Practice Address - Phone:919-233-4848
Practice Address - Fax:919-233-4843
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU38339Medicare UPIN
NC2447766Medicare ID - Type Unspecified