Provider Demographics
NPI:1245258029
Name:STEPHENSON, DOUGLAS JOE (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOE
Last Name:STEPHENSON
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:PO BOX 2338
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34146-2338
Mailing Address - Country:US
Mailing Address - Phone:239-394-7551
Mailing Address - Fax:
Practice Address - Street 1:991 N COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2773
Practice Address - Country:US
Practice Address - Phone:239-394-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55711Medicare UPIN
FL88145Medicare ID - Type Unspecified