Provider Demographics
NPI:1538168687
Name:ANDERSON-SMITH, STEPHANIE ELAINE (DC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:ANDERSON-SMITH
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 1:12 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1408
Mailing Address - Country:US
Mailing Address - Phone:320-257-6008
Mailing Address - Fax:320-257-6009
Practice Address - Street 1:12 2ND AVE S
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1408
Practice Address - Country:US
Practice Address - Phone:320-257-6008
Practice Address - Fax:320-257-6009
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN105540200Medicaid
MNHP47384OtherHEALTH PARTNERS
MN322J7ANOtherBCBS