Provider Demographics
NPI:1427460534
Name:BEAN, STEPHANIE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:BEAN
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 1:6410 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1613
Mailing Address - Country:US
Mailing Address - Phone:612-886-2311
Mailing Address - Fax:612-886-2293
Practice Address - Street 1:555 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3067
Practice Address - Country:US
Practice Address - Phone:651-789-0970
Practice Address - Fax:651-789-0971
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor