Provider Demographics
NPI:1598062770
Name:STEPHANS CHIROPRACTIC PC
Entity type:Organization
Organization Name:STEPHANS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-346-4501
Mailing Address - Street 1:117 W BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2731
Mailing Address - Country:US
Mailing Address - Phone:972-346-4501
Mailing Address - Fax:972-346-4503
Practice Address - Street 1:117 W BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2731
Practice Address - Country:US
Practice Address - Phone:972-346-4501
Practice Address - Fax:972-346-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC10415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty