Provider Demographics
NPI:1881922946
Name:STEFANIK, KIMBERLY RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RENEE
Last Name:STEFANIK
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 1:300 N HIGHWAY A1A
Mailing Address - Street 2:APT. A-201
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-9510
Mailing Address - Country:US
Mailing Address - Phone:954-234-0089
Mailing Address - Fax:
Practice Address - Street 1:300 N HIGHWAY A1A
Practice Address - Street 2:APT. A-201
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-9510
Practice Address - Country:US
Practice Address - Phone:954-234-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7301111NI0900X
SC950111NI0900X
PA2593L111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381317700Medicaid
FLK2135OtherMEDICARE