Basic Information
| Provider Information | |||||||||
| NPI: | 1245352756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACK | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | ALEXANDER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.C., C.S.C.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6214 TERRELL HILLS DR | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774696122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8324183171 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8720 HIGHWAY 6 | ||||||||
| Address2: | STE 400 | ||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774597107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323429204 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 12/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 9319 | TX | N | Chiropractic Providers | Chiropractor | 111NR0400X | 9319 | TX | N | Chiropractic Providers | Chiropractor | Rehabilitation | 111NS0005X | 9319 | TX | N | Chiropractic Providers | Chiropractor | Sports Physician | 363L00000X | AP128914 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.