Provider Demographics
NPI:1508333550
Name:WILLIAMS-BOGUSKIE, STEPHANIE K (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:WILLIAMS-BOGUSKIE
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 476
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-0476
Mailing Address - Country:US
Mailing Address - Phone:816-776-5678
Mailing Address - Fax:816-776-3979
Practice Address - Street 1:918 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1343
Practice Address - Country:US
Practice Address - Phone:660-251-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018093283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor