Provider Demographics
NPI:1639110182
Name:STEPHENSON, KIMBERLY RUSS (DC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RUSS
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:CAROL
Other - Last Name:RUSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1773
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-8773
Mailing Address - Country:US
Mailing Address - Phone:256-773-1113
Mailing Address - Fax:256-751-1772
Practice Address - Street 1:807 RHODES ST NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-4436
Practice Address - Country:US
Practice Address - Phone:256-773-1113
Practice Address - Fax:256-751-1772
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2138111N00000X
SC2997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor