Provider Demographics
NPI:1770540981
Name:REMILLARD, STEVEN M (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:REMILLARD
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 1:4079 DERRY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2238
Mailing Address - Country:US
Mailing Address - Phone:717-558-9292
Mailing Address - Fax:717-558-2006
Practice Address - Street 1:4079 DERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2238
Practice Address - Country:US
Practice Address - Phone:717-558-9292
Practice Address - Fax:717-558-2006
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007090L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16772000003Medicaid
PA2008228OtherHIGHMARK
PA16772000003Medicaid