Provider Demographics
NPI:1396882221
Name:SMOUSE, STEPHANIE MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:SMOUSE
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 1:14015 SOUTHWEST FWY
Mailing Address - Street 2:SUITE #9
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3554
Mailing Address - Country:US
Mailing Address - Phone:281-494-5144
Mailing Address - Fax:281-494-2975
Practice Address - Street 1:14015 SOUTHWEST FWY
Practice Address - Street 2:SUITE #9
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3554
Practice Address - Country:US
Practice Address - Phone:281-494-5144
Practice Address - Fax:281-494-2975
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608359Medicare ID - Type Unspecified