=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356647226
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENT STEPHEN STECK D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2011
-----------------------------------------------------
Last Update Date | 02/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 GROGANS PARK DR SUITE 103
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-2189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-364-1496
-----------------------------------------------------
Fax | 281-364-1489
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2219 SAWDUST RD STE 801
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-2580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-364-1496
-----------------------------------------------------
Fax | 281-364-1489
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 11674
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------