Provider Demographics
NPI:1982246336
Name:STIVISON, AUSTIN JOSHUA (DC)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:JOSHUA
Last Name:STIVISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:AUSTIN
Other - Middle Name:JOSHUA
Other - Last Name:STIVISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2145 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5768
Mailing Address - Country:US
Mailing Address - Phone:208-298-9169
Mailing Address - Fax:
Practice Address - Street 1:2145 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5768
Practice Address - Country:US
Practice Address - Phone:208-298-9169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61004790111NR0400X
IDCHIA-2111111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation