Provider Demographics
NPI:1427303114
Name:FORD, STEPHEN TYLER (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:TYLER
Last Name:FORD
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 1:14688 PERTHSHIRE RD
Mailing Address - Street 2:UNIT E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7699
Mailing Address - Country:US
Mailing Address - Phone:281-770-3613
Mailing Address - Fax:
Practice Address - Street 1:2500 WILCREST DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2752
Practice Address - Country:US
Practice Address - Phone:713-954-4864
Practice Address - Fax:713-588-8445
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor