Provider Demographics
NPI:1215746854
Name:BENJAMIN, STEPHANIE MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:BENJAMIN
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 1:126 I-20 SUITE 120
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087
Mailing Address - Country:US
Mailing Address - Phone:817-803-5450
Mailing Address - Fax:
Practice Address - Street 1:126 I-20 SUITE 120
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76087
Practice Address - Country:US
Practice Address - Phone:817-803-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor