Provider Demographics
NPI:1831107291
Name:OWENS, STEPHANIE CRYSTAL (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CRYSTAL
Last Name:OWENS
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 1:458 KLOTTER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-1917
Mailing Address - Country:US
Mailing Address - Phone:513-665-9004
Mailing Address - Fax:
Practice Address - Street 1:7319 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4001
Practice Address - Country:US
Practice Address - Phone:513-784-0084
Practice Address - Fax:513-784-0086
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2355384Medicaid
OHU98547Medicare UPIN
OHOW4126532Medicare ID - Type Unspecified