Provider Demographics
NPI:1841765609
Name:FERNALD, STEPHANIE ELAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:FERNALD
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 1:3505 STUART AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2120
Mailing Address - Country:US
Mailing Address - Phone:804-519-2764
Mailing Address - Fax:
Practice Address - Street 1:13924 COALFIELD COMMONS PL STE 102
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-1255
Practice Address - Country:US
Practice Address - Phone:804-594-1998
Practice Address - Fax:804-594-3804
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor