Provider Demographics
NPI:1528570686
Name:LACY, CHISTEE (DC)
Entity Type:Individual
Prefix:
First Name:CHISTEE
Middle Name:
Last Name:LACY
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 1:210 W BELT LINE RD STE D
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2081
Mailing Address - Country:US
Mailing Address - Phone:972-616-3027
Mailing Address - Fax:214-602-5364
Practice Address - Street 1:210 W BELT LINE RD STE D
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2081
Practice Address - Country:US
Practice Address - Phone:972-616-3027
Practice Address - Fax:214-602-5364
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor