Provider Demographics
NPI:1508874363
Name:FROST, STEPHANIE ANN (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:FROST
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 1:1007 TUSCULUM BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4113
Mailing Address - Country:US
Mailing Address - Phone:423-798-9710
Mailing Address - Fax:423-798-9722
Practice Address - Street 1:1007 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4113
Practice Address - Country:US
Practice Address - Phone:423-798-9710
Practice Address - Fax:423-798-9722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519721Medicaid
TN3970946Medicare ID - Type Unspecified
TN1519721Medicaid