Provider Demographics
NPI:1093994048
Name:DUCKETT, STACEY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANN
Last Name:DUCKETT
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 1:3432 HILLCREST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6311
Mailing Address - Country:US
Mailing Address - Phone:925-777-3334
Mailing Address - Fax:
Practice Address - Street 1:3432 HILLCREST AVE STE 200
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6311
Practice Address - Country:US
Practice Address - Phone:925-777-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU50561Medicare UPIN