Provider Demographics
NPI:1194768408
Name:STEPHENSON, SCOTT LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LEWIS
Last Name:STEPHENSON
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 1:1406 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-2656
Mailing Address - Country:US
Mailing Address - Phone:979-543-8600
Mailing Address - Fax:979-543-8734
Practice Address - Street 1:1406 NORTH MECHANIC ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437
Practice Address - Country:US
Practice Address - Phone:979-543-8600
Practice Address - Fax:979-543-8734
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601181OtherBLUE CROSS BLUE SHIELD
TX001166002Medicaid
TX609517Medicare UPIN