Provider Demographics
NPI:1265434518
Name:STEPHENSON, JOHANNA RAE (DC)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:RAE
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 1:7301 BURNET RD
Mailing Address - Street 2:STE 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2248
Mailing Address - Country:US
Mailing Address - Phone:512-419-0330
Mailing Address - Fax:512-419-0919
Practice Address - Street 1:7301 BURNET RD
Practice Address - Street 2:STE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-2248
Practice Address - Country:US
Practice Address - Phone:512-419-0330
Practice Address - Fax:512-419-0919
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610847Medicare ID - Type UnspecifiedPROVIDER NUMBER