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General NPI Number Information
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NPI Number | 1598062770
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Entity Type | Organization
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Legal Business Name | STEPHANS CHIROPRACTIC PC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 117 W BROADWAY ST STE A
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City | PROSPER
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State | TX
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Zip | 75078-2731
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Country | US
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Telephone | 972-346-4501
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Fax | 972-346-4503
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Provider Business Mailing Address
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Address Line | 117 W BROADWAY ST STE A
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City | PROSPER
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State | TX
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Zip | 75078-2731
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Country | US
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Telephone | 972-346-4501
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Fax | 972-346-4503
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Authorized Official
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Title or Position | OWNER
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Name | BRANDON STEPHANS
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Credential | DC
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Telephone | 972-346-4501
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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 | DC10415
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License Number State | TX
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