Provider Demographics
NPI:1164422937
Name:STACY, RONALD J II (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:STACY
Suffix:II
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 1:1194 OLD HENDERSON RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3694
Mailing Address - Country:US
Mailing Address - Phone:614-429-3443
Mailing Address - Fax:614-429-3479
Practice Address - Street 1:1194 OLD HENDERSON RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3694
Practice Address - Country:US
Practice Address - Phone:614-429-3443
Practice Address - Fax:614-429-3479
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC3556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2517477Medicaid
OH2517477Medicaid
OHST4145511Medicare ID - Type Unspecified