Provider Demographics
NPI:1235364134
Name:KITCHELL, STACY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ANN
Last Name:KITCHELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:CIUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:232 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1105
Mailing Address - Country:US
Mailing Address - Phone:717-942-2740
Mailing Address - Fax:717-942-2752
Practice Address - Street 1:232 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1105
Practice Address - Country:US
Practice Address - Phone:717-942-2740
Practice Address - Fax:717-942-2752
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ38MC00680600111N00000X
PADC011081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program