Provider Demographics
NPI:1346459021
Name:BRACKEN, STACI LYNN (DC)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:LYNN
Last Name:BRACKEN
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 1:155 BLANDING BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2624
Mailing Address - Country:US
Mailing Address - Phone:904-213-9805
Mailing Address - Fax:904-213-9806
Practice Address - Street 1:461 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4827
Practice Address - Country:US
Practice Address - Phone:904-213-9805
Practice Address - Fax:904-213-9806
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor