Provider Demographics
NPI:1912118225
Name:DENNISTON, STEPHANIE ANN (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:DENNISTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:HOGLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:550 W 465 N
Mailing Address - Street 2:STE 502
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-8015
Mailing Address - Country:US
Mailing Address - Phone:435-232-0732
Mailing Address - Fax:435-514-1814
Practice Address - Street 1:550 W 465 N
Practice Address - Street 2:STE 502
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-8015
Practice Address - Country:US
Practice Address - Phone:435-232-0732
Practice Address - Fax:435-514-1814
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6509860-1202111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor