Provider Demographics
NPI:1932457355
Name:STEPHENS, ANNIE PAMELA (DC,)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:PAMELA
Last Name:STEPHENS
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 1:11673 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073
Mailing Address - Country:US
Mailing Address - Phone:815-623-7694
Mailing Address - Fax:815-623-9689
Practice Address - Street 1:11673 MAIN ST.
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073
Practice Address - Country:US
Practice Address - Phone:815-623-7694
Practice Address - Fax:815-623-9689
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor