Provider Demographics
NPI:1548656739
Name:STEVENSON, JONATHAN (DC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:STEVENSON
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 1:19555 W BLUEMOUND RD
Mailing Address - Street 2:STE 6
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5934
Mailing Address - Country:US
Mailing Address - Phone:262-649-7876
Mailing Address - Fax:
Practice Address - Street 1:19555 W BLUEMOUND RD
Practice Address - Street 2:STE 6
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5934
Practice Address - Country:US
Practice Address - Phone:262-649-7876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60540822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor