Provider Demographics
NPI:1154677748
Name:STEPHENS, ANDREA MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MICHELLE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CODY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2452
Mailing Address - Country:US
Mailing Address - Phone:785-621-0621
Mailing Address - Fax:
Practice Address - Street 1:1007 CODY AVE STE A
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2452
Practice Address - Country:US
Practice Address - Phone:785-621-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor