Provider Demographics
NPI:1023203957
Name:WEST, STEPHANIE MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:WEST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:MICHELLE
Other - Last Name:GAIDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3820 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2552
Mailing Address - Country:US
Mailing Address - Phone:218-343-0997
Mailing Address - Fax:
Practice Address - Street 1:404 W SUPERIOR ST
Practice Address - Street 2:SUITE 225C
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1559
Practice Address - Country:US
Practice Address - Phone:218-722-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor