Provider Demographics
NPI:1376638361
Name:CANADA, STEPHANIE F (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:F
Last Name:CANADA
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:PO BOX 18347
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-0347
Mailing Address - Country:US
Mailing Address - Phone:303-778-9321
Mailing Address - Fax:
Practice Address - Street 1:1633 FILLMORE ST
Practice Address - Street 2:STE 107
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1544
Practice Address - Country:US
Practice Address - Phone:303-778-9321
Practice Address - Fax:303-778-6320
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47613Medicare ID - Type UnspecifiedMEDICARE