Provider Demographics
NPI:1700211240
Name:MUSSMANN, STEPHANIE ELAINE (DC, DACBR)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:MUSSMANN
Suffix:
Gender:F
Credentials:DC, DACBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PORTER AVE
Mailing Address - Street 2:DYC CHIROPRACTIC DEPARTMENT
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1032
Mailing Address - Country:US
Mailing Address - Phone:612-251-3997
Mailing Address - Fax:
Practice Address - Street 1:2900 MAIN ST
Practice Address - Street 2:DYC CHIROPRACTIC HEALTH CENTER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1718
Practice Address - Country:US
Practice Address - Phone:716-923-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70011700111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
No111N00000XChiropractic ProvidersChiropractor