Healthcare Provider Details

I. General information

NPI: 1881922946
Provider Name (Legal Business Name): KIMBERLY RENEE STEFANIK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HIGHWAY A1A APT. A-201
JUPITER FL
33477-9510
US

IV. Provider business mailing address

300 N HIGHWAY A1A APT. A-201
JUPITER FL
33477-9510
US

V. Phone/Fax

Practice location:
  • Phone: 954-234-0089
  • Fax:
Mailing address:
  • Phone: 954-234-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberCH7301
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number950
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number2593L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: