Provider Demographics
NPI:1487244794
Name:STEMBRIDGE, LAWANA NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:LAWANA
Middle Name:NICOLE
Last Name:STEMBRIDGE
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 1:2638 TWO NOTCH RD STE 204
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1454
Mailing Address - Country:US
Mailing Address - Phone:803-380-2227
Mailing Address - Fax:
Practice Address - Street 1:2638 TWO NOTCH RD STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1454
Practice Address - Country:US
Practice Address - Phone:803-380-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC.4634111N00000X
SCDC.4634.DC111N00000X
SCDC.4643.DC111N00000X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0900XChiropractic ProvidersChiropractorInternist