Provider Demographics
NPI:1174238257
Name:STEWART CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:STEWART CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DE'ANDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-566-8619
Mailing Address - Street 1:1605 THOMAS DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2750
Mailing Address - Country:US
Mailing Address - Phone:256-566-8619
Mailing Address - Fax:256-822-2215
Practice Address - Street 1:2114 CENTRAL PKWY SW STE G
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6850
Practice Address - Country:US
Practice Address - Phone:256-777-6762
Practice Address - Fax:256-649-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty