Healthcare Provider Details

I. General information

NPI: 1538168687
Provider Name (Legal Business Name): STEPHANIE ELAINE ANDERSON-SMITH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 2ND AVE S
SAUK RAPIDS MN
56379-1408
US

IV. Provider business mailing address

12 2ND AVE S
SAUK RAPIDS MN
56379-1408
US

V. Phone/Fax

Practice location:
  • Phone: 320-257-6008
  • Fax: 320-257-6009
Mailing address:
  • Phone: 320-257-6008
  • Fax: 320-257-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4294
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: