Provider Demographics
NPI:1538246186
Name:STEWART, KEVIN L (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:STEWART
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 1:400 E KETTLEMAN LN STE 21
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5956
Mailing Address - Country:US
Mailing Address - Phone:209-368-0619
Mailing Address - Fax:209-368-3339
Practice Address - Street 1:400 E KETTLEMAN LN STE 21
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5956
Practice Address - Country:US
Practice Address - Phone:209-368-0619
Practice Address - Fax:209-368-3339
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0233810Medicare ID - Type Unspecified