Provider Demographics
NPI:1093062267
Name:CARTER, STACY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:MARIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:MARIE
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 2711
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-2711
Mailing Address - Country:US
Mailing Address - Phone:315-414-0866
Mailing Address - Fax:
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2167
Practice Address - Country:US
Practice Address - Phone:315-414-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70-012209111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition