Provider Demographics
NPI:1679622856
Name:STEVENER, BRYANT DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:DAVID
Last Name:STEVENER
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 1:501 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-3416
Mailing Address - Country:US
Mailing Address - Phone:603-226-6430
Mailing Address - Fax:603-226-4048
Practice Address - Street 1:501 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-3416
Practice Address - Country:US
Practice Address - Phone:603-226-6430
Practice Address - Fax:603-226-4048
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH563-0799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2806680OtherAETNA
NH352260OtherHARVARD PILGRIM
NH4404392OtherUNITED HEALTHCARE
NH0507739Y0NH01OtherANTHEM BC BS OF NH
NH515210OtherCIGNA
NH0507739Y0NH01OtherANTHEM BC BS OF NH
NH4404392OtherUNITED HEALTHCARE