Provider Demographics
NPI:1437485745
Name:MYINT, STACEY LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LYN
Last Name:MYINT
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 1:7200 DAN HOEY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-4201
Mailing Address - Country:US
Mailing Address - Phone:734-424-9500
Mailing Address - Fax:
Practice Address - Street 1:7200 DAN HOEY RD
Practice Address - Street 2:SUITE F
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-4201
Practice Address - Country:US
Practice Address - Phone:734-424-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor