Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 9319 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 9319 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 9319 | TX |
Y | 363L00000X | Nurse Practitioner | AP128914 | TX |
NPI | 1245352756 |
---|---|
Provider Name | Dr. Stephen Alexander Mack |
First Address | Richmond, TX 77469-6122 |
Second Address | Missouri City, TX 77459-7107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 07/12/2015 |