Provider Demographics
NPI:1568820132
Name:STEPHENS, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 AIRPORT BLVD
Mailing Address - Street 2:300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-4218
Mailing Address - Country:US
Mailing Address - Phone:512-451-0115
Mailing Address - Fax:512-451-1208
Practice Address - Street 1:5775 AIRPORT BLVD
Practice Address - Street 2:300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-4218
Practice Address - Country:US
Practice Address - Phone:512-451-0115
Practice Address - Fax:512-451-1208
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor