Provider Demographics
NPI:1366504896
Name:ASHLEY, STACEY (DC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:ASHLEY
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:PO BOX 5077
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-5077
Mailing Address - Country:US
Mailing Address - Phone:478-275-1338
Mailing Address - Fax:478-275-1747
Practice Address - Street 1:911 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4849
Practice Address - Country:US
Practice Address - Phone:478-275-1338
Practice Address - Fax:478-275-1747
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52893879-003OtherBCBS OF GA
GAU90275Medicare UPIN
GAGRP4509Medicare ID - Type Unspecified