Provider Demographics
NPI:1124359310
Name:ERVIN, STEFANIE SUZANE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:SUZANE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STEFANIE
Other - Middle Name:SUZANE
Other - Last Name:FUESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1154 KINGS BOTTOM DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-5604
Mailing Address - Country:US
Mailing Address - Phone:541-817-5831
Mailing Address - Fax:
Practice Address - Street 1:8040 PROVIDENCE RD STE 500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9762
Practice Address - Country:US
Practice Address - Phone:541-817-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3987111N00000X
SC3822111N00000X
NC4377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor