Provider Demographics
NPI:1255456232
Name:SUMMERS, STEPHEN LYNN (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LYNN
Last Name:SUMMERS
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 1:12701 SHEMYA CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7733
Mailing Address - Country:US
Mailing Address - Phone:512-415-0828
Mailing Address - Fax:
Practice Address - Street 1:3907 MEDICAL PKWY
Practice Address - Street 2:STE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4015
Practice Address - Country:US
Practice Address - Phone:512-458-5880
Practice Address - Fax:512-444-1094
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606282OtherBLUE CROSS BLUE SHIELD
TX601046Medicare ID - Type Unspecified