MEDICARE: DR. JOHANNA RAE STEPHENSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9770	TX

General Provider Information

NPI Number	:	1265434518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHANNA RAE STEPHENSON D.C.

Provider Business Mailing Address
First Line	:	7301 BURNET RD
Second Line	:	STE 104
City	:	AUSTIN
State	:	TX
Zip	:	78757-2248
Country	:	US
Telephone Number	:	512-419-0330
Fax Number	:	512-419-0919

Provider Business Practice Location Address
First Line	:	7301 BURNET RD
Second Line	:	STE 104
City	:	AUSTIN
State	:	TX
Zip	:	78757-2248
Country	:	US
Telephone Number	:	512-419-0330
Fax Number	:	512-419-0919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/09/2007

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