Provider Demographics
NPI:1073651600
Name:SHULENBERGER, STACY ANN (DC, CCEP)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ANN
Last Name:SHULENBERGER
Suffix:
Gender:F
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 DIABLO RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3452
Mailing Address - Country:US
Mailing Address - Phone:925-946-2518
Mailing Address - Fax:
Practice Address - Street 1:383 DIABLO RD
Practice Address - Street 2:SUITE 112
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3452
Practice Address - Country:US
Practice Address - Phone:925-946-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28022111NI0900X, 111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0280220Medicare ID - Type Unspecified