Provider Demographics
NPI:1326497553
Name:BROWN, STACY DENISE (DC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:DENISE
Last Name:BROWN
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 1:4284 MEMORIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1220
Mailing Address - Country:US
Mailing Address - Phone:404-499-9300
Mailing Address - Fax:
Practice Address - Street 1:4284 MEMORIAL DR STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1220
Practice Address - Country:US
Practice Address - Phone:404-499-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor