Provider Demographics
NPI:1144226044
Name:COURSEN, STEPHANIE A (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:COURSEN
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 1:3441 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2739
Mailing Address - Country:US
Mailing Address - Phone:814-864-2225
Mailing Address - Fax:814-868-1199
Practice Address - Street 1:3441 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2739
Practice Address - Country:US
Practice Address - Phone:814-864-2225
Practice Address - Fax:814-868-1199
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007386L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007853650001Medicaid
PA0007853650001Medicaid
PA023540LSDMedicare ID - Type Unspecified