Provider Demographics
NPI:1073840625
Name:VLAMINCK, STEPHANIE ALLECIA (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALLECIA
Last Name:VLAMINCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264-0093
Mailing Address - Country:US
Mailing Address - Phone:507-872-5200
Mailing Address - Fax:507-872-5236
Practice Address - Street 1:110 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MINNEOTA
Practice Address - State:MN
Practice Address - Zip Code:56264-9612
Practice Address - Country:US
Practice Address - Phone:507-872-5200
Practice Address - Fax:507-872-5236
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN5382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program