Provider Demographics
NPI:1467430314
Name:ZGRAGGEN, STEPHANIE M (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:ZGRAGGEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:LATTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:925 WAPPOO RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5969
Mailing Address - Country:US
Mailing Address - Phone:843-214-2997
Mailing Address - Fax:
Practice Address - Street 1:925 WAPPOO RD
Practice Address - Street 2:SUITE F
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5969
Practice Address - Country:US
Practice Address - Phone:843-214-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-01
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2965111NN1001X
CA32542111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCV02696Medicare UPIN
SCV02696Medicare UPIN