Provider Demographics
NPI:1952310674
Name:PAUTLER-BEA, STEPHANIE ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ROSE
Last Name:PAUTLER-BEA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:ROSE
Other - Last Name:PAUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:13305 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1324
Mailing Address - Country:US
Mailing Address - Phone:716-902-5261
Mailing Address - Fax:716-902-4303
Practice Address - Street 1:13305 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1324
Practice Address - Country:US
Practice Address - Phone:716-902-5261
Practice Address - Fax:716-902-4303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor