Provider Demographics
NPI:1255680989
Name:MURRAY, STACIE AMANDA (DC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:AMANDA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5854 SNYDER DR
Mailing Address - Street 2:A
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9497
Mailing Address - Country:US
Mailing Address - Phone:716-434-1780
Mailing Address - Fax:716-434-3868
Practice Address - Street 1:5854 SNYDER DR
Practice Address - Street 2:A
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9497
Practice Address - Country:US
Practice Address - Phone:716-434-1780
Practice Address - Fax:716-434-3868
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010613111N00000X
NY012640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor