Healthcare Provider Details

I. General information

NPI: 1669870796
Provider Name (Legal Business Name): DR. STEPHANIE PAUTLER-BEA, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 BROADWAY ST
ALDEN NY
14004-1324
US

IV. Provider business mailing address

13305 BROADWAY ST
ALDEN NY
14004-1324
US

V. Phone/Fax

Practice location:
  • Phone: 716-902-5261
  • Fax: 716-902-4303
Mailing address:
  • Phone: 716-902-5261
  • Fax: 716-902-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number011323
License Number StateNY

VIII. Authorized Official

Name: DR. STEPHANIE ROSE PAUTLER-BEA
Title or Position: PRESIDENT/CHIROPRACTOR
Credential: D.C.
Phone: 716-902-5261