Provider Demographics
NPI:1679938302
Name:STEVENS, JOHN C
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 S MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80929-9712
Mailing Address - Country:US
Mailing Address - Phone:719-660-1569
Mailing Address - Fax:
Practice Address - Street 1:3025 S MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80929-9712
Practice Address - Country:US
Practice Address - Phone:719-660-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications