Stephen Gary Verbovanec, DC
Individual provider Active NPI Chiropractor · Watkins, MN
NPI 1154496701 · NPPES record last updated Aug 6, 2007
Key facts
- NPI
- 1154496701
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2458 (MN)
- Practice address
- 165 Central Ave
Watkins, MN 55389 - Phone
- (320) 764-3000
- Fax
- (320) 764-3000
- NPI assigned
- Nov 21, 2006
- Reactivated
- Aug 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041215000219 | MN | Practitioner - Chiropractic | 5698732246 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rockford Chiropractic Corporation | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2458 | MN | Yes |
Addresses
Primary practice location
165 Central Ave
Watkins, MN 55389
Mailing address
PO Box 39
Watkins, MN 55389
Phone (320) 764-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 356K6WA | Other | MN | BLUE CROSS BLUE SHIELD |
Other providers in Watkins, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.