Provider Demographics
NPI:1003129966
Name:YOUNG, STACEY HAAS (DC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:HAAS
Last Name:YOUNG
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 1:17330 SUNSET MAPLE LN
Mailing Address - Street 2:1611
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-6015
Mailing Address - Country:US
Mailing Address - Phone:317-757-9442
Mailing Address - Fax:
Practice Address - Street 1:785 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9440
Practice Address - Country:US
Practice Address - Phone:317-399-5695
Practice Address - Fax:317-804-8300
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08005215A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201152900AMedicaid
ININ1087Medicare PIN