Provider Demographics
NPI:1417107475
Name:DAVIS, STACY ERIN (DOM, DIPL OM)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ERIN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DOM, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5713
Mailing Address - Country:US
Mailing Address - Phone:307-514-1498
Mailing Address - Fax:
Practice Address - Street 1:136 COLE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5366
Practice Address - Country:US
Practice Address - Phone:307-286-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist