Provider Demographics
NPI:1447222492
Name:JONES, STACEY L (DC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:JONES
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 1:1403 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2326
Mailing Address - Country:US
Mailing Address - Phone:610-439-3990
Mailing Address - Fax:610-351-3971
Practice Address - Street 1:1403 N CEDAR CREST BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2326
Practice Address - Country:US
Practice Address - Phone:610-439-3990
Practice Address - Fax:610-351-3971
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007142L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA031778Medicare ID - Type Unspecified
PAI77416Medicare UPIN