Provider Demographics
NPI:1992070759
Name:STEPHENSON, ALICIA MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MICHELLE
Last Name:STEPHENSON
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 1:1313 BRIARCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5241
Mailing Address - Country:US
Mailing Address - Phone:979-776-2828
Mailing Address - Fax:979-776-2829
Practice Address - Street 1:1313 BRIARCREST DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5241
Practice Address - Country:US
Practice Address - Phone:979-776-2828
Practice Address - Fax:979-776-2829
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor