Provider Demographics
NPI:1700044294
Name:O'BRIEN, STEPHANIE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:O'BRIEN
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 1:3172 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1244
Mailing Address - Country:US
Mailing Address - Phone:404-370-8050
Mailing Address - Fax:404-370-7604
Practice Address - Street 1:3172 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1244
Practice Address - Country:US
Practice Address - Phone:404-370-8050
Practice Address - Fax:404-370-7604
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBWPMedicare UPIN