Provider Demographics
NPI:1942285044
Name:EASLEY, STEPHANIE JERNIGAN (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JERNIGAN
Last Name:EASLEY
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 1:2812 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-6106
Mailing Address - Country:US
Mailing Address - Phone:936-336-3381
Mailing Address - Fax:936-336-8438
Practice Address - Street 1:2812 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-6106
Practice Address - Country:US
Practice Address - Phone:936-336-3381
Practice Address - Fax:936-336-8438
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU96390Medicare UPIN
TX609857Medicare ID - Type Unspecified