Provider Demographics
NPI:1619197209
Name:STEPANIUK, STEPHEN A (DC, QME)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:STEPANIUK
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 MOTOR AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3196
Mailing Address - Country:US
Mailing Address - Phone:310-841-6361
Mailing Address - Fax:
Practice Address - Street 1:14623 HAWTHORNE BLVD #406
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:877-204-5682
Practice Address - Fax:310-356-7910
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28023111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner