Provider Demographics
NPI:1366843583
Name:LACEY, MITZI ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MITZI
Middle Name:ANN
Last Name:LACEY
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 1:4520 S FM 565 RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-4884
Mailing Address - Country:US
Mailing Address - Phone:281-383-0004
Mailing Address - Fax:281-383-0007
Practice Address - Street 1:4520 S FM 565 RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523-4884
Practice Address - Country:US
Practice Address - Phone:281-383-0004
Practice Address - Fax:281-383-0007
Is Sole Proprietor?:No
Enumeration Date:2014-09-07
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor