Provider Demographics
NPI:1730792425
Name:HINESLEY, STEFANIE MARA (DC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MARA
Last Name:HINESLEY
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 1:1316 CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3142
Mailing Address - Country:US
Mailing Address - Phone:615-885-8282
Mailing Address - Fax:
Practice Address - Street 1:1316 CENTRAL CT
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3142
Practice Address - Country:US
Practice Address - Phone:615-885-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor