Provider Demographics
NPI:1164074274
Name:VICENS BEARD, STEPHANIE (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:VICENS BEARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STEPHANNIE
Other - Middle Name:
Other - Last Name:VICENS BEARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:190 E 9TH AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2744
Mailing Address - Country:US
Mailing Address - Phone:303-322-9141
Mailing Address - Fax:
Practice Address - Street 1:190 E 9TH AVE STE 135
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2744
Practice Address - Country:US
Practice Address - Phone:303-322-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor