Provider Demographics
NPI:1114307212
Name:BEAVERS, STEPHANIE LEE (DC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEE
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:LEE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, CCSP
Mailing Address - Street 1:524 BUCKSTONE DR.
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179
Mailing Address - Country:US
Mailing Address - Phone:682-553-8144
Mailing Address - Fax:817-557-1795
Practice Address - Street 1:524 BUCKSTONE DR.
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179
Practice Address - Country:US
Practice Address - Phone:682-553-8144
Practice Address - Fax:817-557-1795
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12795111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor