Provider Demographics
NPI:1518150614
Name:POLASEK, STACEY LYNN (D C)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:POLASEK
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 N FRY RD
Mailing Address - Street 2:#190
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449
Mailing Address - Country:US
Mailing Address - Phone:281-829-3577
Mailing Address - Fax:281-829-3574
Practice Address - Street 1:3616 N FRY RD
Practice Address - Street 2:#190
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449
Practice Address - Country:US
Practice Address - Phone:281-829-3577
Practice Address - Fax:281-829-3574
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor