Provider Demographics
NPI:1215013594
Name:CROFT, STACY CARUSO (DC)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:CARUSO
Last Name:CROFT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:LEE
Other - Last Name:CARUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1039 ELDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2811
Mailing Address - Country:US
Mailing Address - Phone:281-494-1690
Mailing Address - Fax:281-494-1691
Practice Address - Street 1:1039 ELDRIDGE RD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2811
Practice Address - Country:US
Practice Address - Phone:281-494-1690
Practice Address - Fax:281-494-1691
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6971OtherCHIRO LICENSE NUMBER
TXU62565Medicare UPIN
TX605486Medicare ID - Type UnspecifiedMEDICARE/BCBS NUMBER