MEDICARE: DR. STEPHANIE L DE LA TORRE D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	01-04544	KS

General Provider Information

NPI Number	:	1154521300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE L DE LA TORRE D.C

Provider Business Mailing Address
First Line	:	1854 MINNESOTA AVE
Second Line	:	SUITE 4
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4122
Country	:	US
Telephone Number	:	913-321-8182
Fax Number	:	913-321-8186

Provider Business Practice Location Address
First Line	:	1854 MINNESOTA AVE
Second Line	:	SUITE 4
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4122
Country	:	US
Telephone Number	:	913-321-8182
Fax Number	:	913-321-8186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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