Provider Demographics
NPI:1174631386
Name:STEPHENS, MELISSA ANN (DC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:STEPHENS
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 1:1702 DUNLAVY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1010
Mailing Address - Country:US
Mailing Address - Phone:713-529-1262
Mailing Address - Fax:713-529-3746
Practice Address - Street 1:1702 DUNLAVY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1010
Practice Address - Country:US
Practice Address - Phone:713-529-1262
Practice Address - Fax:713-529-3746
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 5057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU14242Medicare UPIN
TX603103Medicare ID - Type UnspecifiedBCBS ID# / MEDICARE