Provider Demographics
NPI:1851490346
Name:DEFIORE, STEPHEN FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRANK
Last Name:DEFIORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 S BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:TX
Mailing Address - Zip Code:76825-6609
Mailing Address - Country:US
Mailing Address - Phone:325-597-5977
Mailing Address - Fax:325-597-9661
Practice Address - Street 1:1407 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-6609
Practice Address - Country:US
Practice Address - Phone:325-597-5977
Practice Address - Fax:325-597-9661
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4151OtherCHIROPRACTIC LICENSE
TX4151OtherCHIROPRACTIC LICENSE
TX8B6192Medicare PIN