Provider Demographics
NPI:1225011026
Name:STALLINGS, SPICHAEL L (DC)
Entity Type:Individual
Prefix:DR
First Name:SPICHAEL
Middle Name:L
Last Name:STALLINGS
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 1:132 SAINT ANDREWS DR. STE D
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128
Mailing Address - Country:US
Mailing Address - Phone:675-217-4564
Mailing Address - Fax:675-217-4566
Practice Address - Street 1:132 SAINT ANDREWS DR STE D
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-3529
Practice Address - Country:US
Practice Address - Phone:675-217-4564
Practice Address - Fax:675-217-4566
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCHOOO2525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050740700Medicaid
FLT54999Medicare UPIN
FL050740700Medicaid