Provider Demographics
NPI:1609839059
Name:EBERT, STACY L (DC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:EBERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:EBERT-LEVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:6511 STEWART RD
Mailing Address - Street 2:STE 7
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1896
Mailing Address - Country:US
Mailing Address - Phone:409-744-2225
Mailing Address - Fax:409-744-2253
Practice Address - Street 1:699 S FRIENDSWOOD DR
Practice Address - Street 2:STE 105
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4580
Practice Address - Country:US
Practice Address - Phone:281-648-0001
Practice Address - Fax:281-648-0146
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8309124OtherBLUELINK
TX8S7574OtherBCBS
TX8S7574OtherBCBS
TX8G5377Medicare PIN