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General NPI Number Information
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NPI Number | 1184807315
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Entity Type | Organization
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Legal Business Name | STEPHANIE M JANIAK
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 5800 LOVELL AVE STE 164
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City | FORT WORTH
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State | TX
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Zip | 76107-5028
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Country | US
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Telephone | 817-423-2600
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Fax | 817-423-2601
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Provider Business Mailing Address
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Address Line | PO BOX 101134
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City | FORT WORTH
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State | TX
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Zip | 76185-1134
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Country | US
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Telephone | 817-423-2600
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Fax | 817-423-2601
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. STEPHANIE MARIE JANIAK
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Credential | DC
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Telephone | 817-423-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 10559
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License Number State | TX
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