Provider Demographics
NPI:1992747638
Name:STANGE, STEPHANIE E (DC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:STANGE
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:PO BOX 2125
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2125
Mailing Address - Country:US
Mailing Address - Phone:903-818-1972
Mailing Address - Fax:
Practice Address - Street 1:19295 US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5888
Practice Address - Country:US
Practice Address - Phone:903-818-1972
Practice Address - Fax:903-893-4425
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1753261-01Medicaid
TX350055158OtherRR MEDICARE
TX8G1690OtherBCBS
TX8618B0Medicare ID - Type UnspecifiedMEDICARE
TX8G1690OtherBCBS