Provider Demographics
NPI:1477694446
Name:LENISA, STACEY A (DC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:A
Last Name:LENISA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:164 W. MAIN STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774
Mailing Address - Country:US
Mailing Address - Phone:301-865-8333
Mailing Address - Fax:301-865-8373
Practice Address - Street 1:164 W. MAIN STREET
Practice Address - Street 2:SUITE D
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774
Practice Address - Country:US
Practice Address - Phone:301-865-8333
Practice Address - Fax:301-865-8373
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU62899Medicare UPIN