=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255456232
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN LYNN SUMMERS DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 04/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3907 MEDICAL PKWY STE 102
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78756-4015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-458-5880
-----------------------------------------------------
Fax | 512-444-1094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12701 SHEMYA CV
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78729-7733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-415-0828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2770
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------