Provider Demographics
NPI:1114227576
Name:STACI L. PRICE, DC, PA
Entity Type:Organization
Organization Name:STACI L. PRICE, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRICE-MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-585-8644
Mailing Address - Street 1:1539 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2393
Mailing Address - Country:US
Mailing Address - Phone:727-585-8644
Mailing Address - Fax:727-449-1981
Practice Address - Street 1:1539 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2393
Practice Address - Country:US
Practice Address - Phone:727-585-8644
Practice Address - Fax:727-449-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381195600Medicaid
FL1710987599OtherINDIVIDUAL NPI
FL1710987599OtherINDIVIDUAL NPI
FLE2799AMedicare PIN