Provider Demographics
NPI:1144231697
Name:COHEN, STACY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:SCOTT
Last Name:COHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 CAPITOL TRL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5716
Mailing Address - Country:US
Mailing Address - Phone:302-454-1200
Mailing Address - Fax:302-454-1238
Practice Address - Street 1:1536 CAPITOL TRL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5716
Practice Address - Country:US
Practice Address - Phone:302-454-1200
Practice Address - Fax:302-454-1238
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDEF10000192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC0456846Medicare PIN
DET26986Medicare UPIN