Individual
DR. NATHAN A STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 WEST MAIN, OLNEY, IL 62450-2623
(618) 395-2225
Mailing address
PO BOX 247, OLNEY, IL 62450-0247
(618) 395-2225
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
038-008490
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038008490
—
IL
01
—
08022501
BLUE CROSS BLUE SHIELD
IL
01
—
350044665
RAILROAD MEDICARE
IL
Enumeration date
08/25/2006
Last updated
07/16/2012
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