Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 12795 | TX |
Y | 111NS0005X | Chiropractic Sports Physician | 12795 | TX |
NPI | 1114307212 |
---|---|
Provider Name | Mrs. Stephanie Lee Beavers |
First Address | Saginaw, TX 76179 |
Second Address | Saginaw, TX 76179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2015 |
Last Update Date | 24/09/2018 |