Provider Demographics
NPI:1578787651
Name:BURRY, STEPHANIE MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:BURRY
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 1:1772 TIDEWELL TRCE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3039
Mailing Address - Country:US
Mailing Address - Phone:678-656-1669
Mailing Address - Fax:
Practice Address - Street 1:3460 SUMMIT RIDGE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1623
Practice Address - Country:US
Practice Address - Phone:770-813-0087
Practice Address - Fax:770-813-9006
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07709111N00000X, 111NN0400X, 111NR0200X, 111NR0400X, 111NS0005X, 111NT0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiology
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NT0100XChiropractic ProvidersChiropractorThermography
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic