Provider Demographics
NPI:1518067776
Name:MARSDEN, STEPHANIE LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LEE
Last Name:MARSDEN
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 1:3302 W BROADWAY BUSINESS PARK CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0169
Mailing Address - Country:US
Mailing Address - Phone:573-445-3702
Mailing Address - Fax:573-445-3721
Practice Address - Street 1:3304 W BROADWAY BUSINESS PARK CT
Practice Address - Street 2:SUITE I
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0109
Practice Address - Country:US
Practice Address - Phone:573-445-3702
Practice Address - Fax:573-445-3721
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004027734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7068876OtherAETNA PIN
MO692377OtherHEALTHLINK PIN
MO195528OtherBLUE CROSS PIN
MO258015379Medicare PIN
MO7068876OtherAETNA PIN