Provider Demographics
NPI:1942436308
Name:ROTTELL, STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:ROTTELL
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 1:2718 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1130
Mailing Address - Country:US
Mailing Address - Phone:510-205-5442
Mailing Address - Fax:510-849-1808
Practice Address - Street 1:2718 TELEGRAPH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1130
Practice Address - Country:US
Practice Address - Phone:510-205-5442
Practice Address - Fax:510-849-1808
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30928111N00000X
COCHR-6222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor