Provider Demographics
NPI:1043520232
Name:STRAW, STACY LEIGH (DC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEIGH
Last Name:STRAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5169
Mailing Address - Country:US
Mailing Address - Phone:386-673-0201
Mailing Address - Fax:386-677-8143
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 305
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5169
Practice Address - Country:US
Practice Address - Phone:386-673-0201
Practice Address - Fax:386-677-8143
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor