Provider Demographics
NPI:1245862937
Name:STEPHENSON, KAILEE (DC)
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:STEPHENSON
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 1:825 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556-2463
Mailing Address - Country:US
Mailing Address - Phone:660-833-8014
Mailing Address - Fax:660-265-0068
Practice Address - Street 1:825 N PEARL ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-2463
Practice Address - Country:US
Practice Address - Phone:660-833-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020002830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor