Provider Demographics
NPI:1376098129
Name:HARKINS, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HARKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 WALLER ST
Mailing Address - Street 2:
Mailing Address - City:LARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1554
Mailing Address - Country:US
Mailing Address - Phone:570-466-2558
Mailing Address - Fax:
Practice Address - Street 1:1 OHIO RIVER BLVD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143
Practice Address - Country:US
Practice Address - Phone:570-466-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60663950111N00000X
PADC011180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8900495Medicare UPIN