Provider Demographics
NPI:1962908822
Name:GATES, STEPHANIE MARIE (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:GATES
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 OLD HOOK RD STE 3E
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3130
Mailing Address - Country:US
Mailing Address - Phone:201-666-4466
Mailing Address - Fax:201-666-4948
Practice Address - Street 1:217 OLD HOOK RD STE 3E
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3130
Practice Address - Country:US
Practice Address - Phone:201-666-4466
Practice Address - Fax:201-666-4948
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00751800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor