Provider Demographics
NPI:1871621730
Name:STEPHANS, BRANDON KIRK (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KIRK
Last Name:STEPHANS
Suffix:
Gender:M
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:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-0788
Mailing Address - Country:US
Mailing Address - Phone:972-346-4501
Mailing Address - Fax:972-346-4503
Practice Address - Street 1:117 W BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2731
Practice Address - Country:US
Practice Address - Phone:972-346-4501
Practice Address - Fax:972-346-4503
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor