Provider Demographics
NPI:1639277841
Name:STUCKEY, TROY DENNIS
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:DENNIS
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3712
Mailing Address - Country:US
Mailing Address - Phone:651-779-8883
Mailing Address - Fax:651-779-8898
Practice Address - Street 1:2574 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-3712
Practice Address - Country:US
Practice Address - Phone:651-779-8883
Practice Address - Fax:651-779-8898
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002136Medicare ID - Type Unspecified