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General NPI Number Information
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NPI Number | 1205074523
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Entity Type | Organization
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Legal Business Name | STEPHANIE DENTON LLC
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 1000 LAKE SAINT LOUIS BLVD SUITE 100
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1340
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Country | US
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Telephone | 636-695-4570
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Fax | 636-625-4554
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Provider Business Mailing Address
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Address Line | 1000 LAKE SAINT LOUIS BLVD SUITE 100
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1340
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Country | US
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Telephone | 636-695-4570
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Fax | 636-625-4554
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Authorized Official
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Title or Position | MEMBER
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Name | DR. STEPHANIE HEAVENER DENTON
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Credential | D.C.
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Telephone | 636-695-4570
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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 | 2009000021
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License Number State | MO
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